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In reviewing Lindsay Lohan’s appearance on David Letterman’s show, most are focusing on the content, which included cringe-inducing questions about her addicitons and stints in rehab. While these moments offered their own insights into her struggles, what continued to speak to me was the quality of her voice. I’d discussed this before, after her appearance on Saturday Night Live, specifically how a hoarse voice might limit the vocal dynamics of an actor, thereby limiting their acting abilities.
Hoarseness is a serious problem, particularly for those who use their voices for a living. It happens for many reasons, some reversible and some not.
Why does hoarseness/raspiness occur?
A clear, easy-to-use voice requires:
- Straight edges of the vocal cords
- Regular and symmetric vibration of the vocal cords
- No space between the vocal cords
- No mucous on the vocal cords
- Healthy lungs
- Healthy vocal tract (includes mouth, nose, sinuses, etc)
Hoarseness occurs when there is damage to the vocal cords that either disrupts the straight edge of the vocal cord or that disrupts the vibration of the vocal cords. The other factors listed above are more important for ease of voice use and vocal tone.
This video is an example of videostroboscopy of a normal singer, which demonstrates straight vocal edges and symmetric vibration:
What can disrupt a straight vocal edge?
Many injuries will cause the vocal edge to be irregular, thereby causing hoarseness. These include:
As you can see in the following picture, a polyp will make the edge of the vocal cord irregular, which will disrupt vibration.
What can disrupt the vibration of the vocal cords?
Even when the edges are straight, scarring can also dampen vibrations and make them irregular. Scarred vocal cords have lost their ability to vibrate due to a loss of the vibrating layer of the vocal cords. There is currently no cure for the loss of vibration due to scarring. This video demonstrates dampened vibration from scarring.
What causes scar?
Scarring of the vocal cords occurs for many reasons but is essentially due to vocal trauma. Vocal trauma can include:
- Talking loudly/yelling frequently
- Singing incorrectly
- Talking or singing too much or too loudly
- Smoking (anything)
- Chronic cough/throat clearing
Any behavior that causes inflammation of the vocal cords will result in a higher likelihood of scarring. Videostroboscopy is the only non-operative way to determine the presence of scarring. A “scope in the nose” cannot diagnose scarring.
Many of the causes of hoarseness are treatable and almost all can be improved. It is important to recognize that hoarseness that lasts more than a few days is not normal and professional evaluation by a skilled laryngologist/voice doctor should be sought. Within the first few days of onset of hoarseness, it is often reversible. Given how limiting hoarseness is for a professional voice user, it is critical to seek care before the hoarseness becomes permanent.
Read patient stories about Dr. Reena Gupta from The Division of Voice at the Osborne Head and Neck Institute.
To learn more about the voice, click here.