Oct. 23, 2008 — -- Losing your voice can be like losing an arm. Suddenly handicapped, you may find that getting through the day can be a mix of frantic gesturing and fumbling for pen and paper.
Voice loss can be brought on by lesions, polyps or other damage to the vocal cords, more accurately known as vocal folds. But even a simple cold virus can lead to voice loss.
"One very common thing is to hear patients come in when they've had a runny nose and all of a sudden, their voice is gone," said Dr. Ramon Franco, medical director of the Voice and Speech Lab at the Massachusetts Eye and Ear Infirmary.
As a working professional singer in Boston, Jessica Cooper finds most of her gigs take place during the holidays between September and May -- the height of cold season.
"It's happened more than once," Cooper said of losing her voice. "One out of every three times I have a cold that happens."
Healthy vocal folds, located above the windpipe in the throat, need to be well lubricated and pliable in order to vibrate rapidly and close fully, producing the best sounds. Irritation and inflammation can stiffen the folds so that they do not vibrate as well or come together completely, producing a rough, breathy sound.
Any extra stress on the folds, from a viral infection, singing or eating the wrong foods, can lead to voice loss.
In December, Cooper had to forgo her first performance with the Boston Baroque choir, one of the most prestigious musical groups in the country, because she lost her voice after getting a cold.
"Usually I can sing through the first couple of days [of a cold]," Cooper said. But after two four-hour rehearsals, her soprano voice was in no condition to sing Handel's "Messiah."
"I couldn't sing at that level. There was no way my voice had the agility," Cooper said. "I couldn't just show up and open my mouth and pretend. … It was my first gig with them and I was upset."
Cooper said she tries to focus on cold prevention in order to avoid losing her voice.
If voice problems persist longer than two weeks after getting ill, doctors recommend getting checked out. But there are some home remedies rumored to help regain a lost voice before that happens. Some methods may help, some won't harm you and some should definitely be avoided.
Here are a few guidelines that might help you get back your lost voice.
Myth: Drink tea with lemon and honey.
There is nothing wrong with honey, but tea and lemon are both acidic, which poses a serious problem to anyone who wants their voice to return.
The vocal folds are made of delicate, epithelial tissue. Though food may not come in contact with them directly during food consumption (if it did, you would choke), acidic foods can trigger acid reflux, bathing the throat area in corrosive stomach acids.
"Spraying a little acid in the larynx has a lot more consequence than in the esophagus," Franco said.
And the vocal folds are already subject to chronic low levels of inflammation because of normal reflux events that occur up to 50 times during the day.
Tomatoes, citrus fruits and chocolate are some acidic foods to avoid to prevent reflux and further damage to the vocal folds.
Warm drinks can be soothing, however, so herbal or caffeine-free teas are better options than caffeinated ones.
Myth: Slippery elm is a natural remedy for a raspy voice.
Tea or lozenges made from the bark of the slippery elm tree has long been used as a remedy for sore, scratchy throats because it contains a gooey substance meant to be soothing. Singers go for the remedy, but there is no scientific evidence showing slippery elm is effective at protecting the voice or healing vocal folds.
"People want to take pills and get better right away," said Dr. Clark Rosen, director of the Voice Center at the University of Pittsburgh. "It's tough to tell if it's a placebo or real."
But doctors admit that remedies such as slippery elm will not do any harm, particularly if someone finds it comforting to try it.
Simple and effective, staying hydrated is one of the best things to do when struggling with throat and voice problems.
Viral infections and colds, as well as some of the medications people take when they are sick, cause dehydration and impair the body's ability to produce lubrication naturally.
"Moist is good for the voice," said Dr. Norman Hogikyan, a professor and director of the Vocal Health Center at the University of Michigan Medical School.
Water can help bring back a lost voice by lubricating the vocal folds and the rest of the throat. The vocal folds vibrate about 100 times per second in men and about 200 times per second in women. Water is necessary to keep that amount of friction from wearing down the epithelial tissue.
"Vibration of that lining is the fundamental source of sound," Hogikyan said. If it doesn't respond the way it normally does, it results in hoarseness.
Water is also a major component of the jelly matrix that comprises the bulk of the vocal folds. Hydration keeps the folds at the correct fullness so that they vibrate well and are not too tense to close properly, which creates a ragged, croaky sound.
Using humidifiers or breathing steam can serve the same purpose, offering just a little more hydration to the sinuses and throat to promote healing.
"It's tough to prevent getting a viral infection, shorten it or get rid of it," said Dr. Clark Rosen, director of the Voice Center at the University of Pittsburgh. "We have to learn how to live with it and minimize the impact of viral infections to the throat."
Myth: Have a hot toddy.
Warm and sweet with a splash of alcohol and perhaps a few spices, hot toddies could be considered the beverage version of curling up in front of a fire on a winter night. The warming drinks, fortified with brandy, rum or whiskey, were thought to stave off viral infections and soothe a raspy voice. But experts advise staying away from hot toddies.
"It feels like it's going down there and cleaning things out," Franco said. "You can drink all you want but it won't get down into the area that's inflamed. And you'll pay for it later."
Sick with a viral infection and struggling to speak, the body is already in need of moisture. Alcohol compounds this effect because it is dehydrating. Hot toddies have no demonstrated curative effects and their moisture-sapping qualities make them less than ideal beverages for those who want to heal their voices.
In addition, hot toddies are often made with tea and lemon or orange, which promote acid reflux.
"In the end they're actually causing more damage than good," Franco said.
Myth: Whisper if you want to be heard.
Forcing sounds when the vocal folds are inflamed is not recommended for fast healing because it smacks the vocal folds together with more force than they normally use.
'Mechanical stress causes inflammation on its own," Franco said.
The extra stress on the folds, from whispering or even loud throat clearing, can exacerbate already inflamed and irritated tissues, increasing the time required to heal.
Resting the vocal folds and throat by keeping silent is one of the best ways to promote healing. This would include refraining from singing, minimizing time spent on the telephone and avoiding whispering or talking over loud music or crowds.
But a person's natural tendency to want to be heard can interfere with this plan.
"People keep using or abusing their voice while they're sick," Rosen said. "The vocal folds are much more prone to permanent injury [polyps, cysts, scar tissue] when they're swollen."
The problem is particularly bad for people who use their voices often during work, including singers, teachers, salespeople and radio and television personalities. Any extra inflammation or damage can affect them more than someone who does not use their voice as often.
"Whenever they get a cold, it seems to affect their voice disproportionately more than anything else," Franco said.
Ultimately, for anyone, regaining a lost voice is simply a matter of time.
"Listen to your voice if it's complaining to you because it's probably telling you something," Hogikyan said.