of Republican presidential nominee Donald Trump cheer during the election night event at the New York Hilton Midtown on November
8, 2016 in New York City. Photo by Chip Somodevilla/Getty Images
This Friday, an estimated 800,000 people will descend on Washington, D.C., for President-elect Donald Trump’s inauguration
ceremony. A day later, protesters plan to join the fray at the Women’s March. One bridge will unite the supporters and naysayers
alike: full-throated yelling.
When the dust settles, many may complain of hoarse voices, but why? Your vocal cords are mostly muscle. But unlike like
your thighs or biceps after an overzealous gym session, your vocal cords don’t hurt when you strain them.
The explanation exposes how little is generally known about our resilient noisemakers and how those body parts age.
Your throat’s black box
“The larynx is a fascinating organ, and a black box to most — even most doctors,” University of Southern California
laryngologist Michael Johns said. “The voice is obviously our primary mode of communication as people, and it’s one of those
things that you kind of take for granted.”
There’s this myth among singers that if you drink hot lemon tea, that’s going to help because
the vocal folds gets bathed in the tea. That’s completely false.
Situated in the upper throat, the larynx, or voice box, is a passageway that guides air between the mouth and lungs. But
the larynx also houses a slitted piece of flabby muscle, known as the vocal cords or vocal folds, which is responsible for
your voice. The two sides of your vocal cords bash rapidly together — 100 and 200 times per second in men and women,
respectively — to create sounds required for human speech and singing.
“You figure over the course of a day of voice use, that’s millions and millions of collisions,” Johns said. The vocal cords
are primarily muscle tissue, which power this repetitive exercise. This muscle is covered with sturdy, connective tissue and
then a outer “skin” layer that makes mucus.
Vocal cords illustration by p6m5/via Adobe
This snot is crucial for your voice. It lubricates the vocal folds and keeps them from stiffening or damage due to those
rapid impacts. This moistness, in turn, influences the pace of the vocal cords’ vibrations — or mucosal wave.
“The vocal folds have a very specific viscosity, and you need that viscosity to create the mucosal wave,” said Susan Thibeault,
an otolaryngologist and surgeon at the University of Wisconsin.
Mucus, or rather the lack of it, explains why talking becomes difficult in dry or cold weather.
“Warmer air holds more water than colder air. Same thing goes for dry climates versus humid climates,” Johns said. “When
there’s less hydration, there’s less lubrication, and when there’s less lubrication, just like oil in your car engine, there’s
going to be more wear and tear on the parts.”
The vocal cords during phonation — the rapid, periodic
opening and closing that creates different sounds and pitches. Muscle (red), connective tissue (yellow) and mucus-making “skin”
layer (brown) are indicated. Image by Reinhard/via wikimedia
Intense voice usage, such as singing for hours and screaming at a concert, can also dry out and damage the mucous membrane.
This skin layer cracks, or pieces of it slough off faster than they can be replaced. You might expect for these events to
hurt, but they don’t.
“One thing that’s missing in the voice is a natural feedback for warning signs,” Johns said. “So when you get hoarse or
maybe [when] you’ve had laryngitis, it doesn’t hurt.”
That’s because, unlike other muscles, your vocal folds don’t contain pain nerves. From an evolutionary perspective, this
dearth makes sense, Johns said. The mammalian larynx and vocal folds originally evolved to protect the airway from choking
(or aspirating) on things like water or food. It’s only later that the human brain evolved the coordination with our tongue,
palate and lips to create speech. If there were a lot of pain receptors in the larynx, then you’d be more prone to think something
is wrong and aspirate.
Lasers are better than acid
Thibeault said if a person continues to misuse or overuse their voice, then the stress can also aggravate the inner connective
tissue, called the lamina propria. The lamina propria is where people develop little masses called cysts, polyps or nodules.
Cysts and polyps resemble swollen bumps on the vocal cords, while nodules are like calluses. For most folks, these lesions
are benign, but for singers, the injuries can be career threatening.
Such was the case for British singer and songwriter Adele. In 2011, a polyp — a kind of swollen blister — burst inside the British singer’s vocal cords
and caused a hemorrhage. She suspended her tour and sought out Steven Zeitels, a laryngeal surgeon at Massachusetts General
Hospital in Boston, who is known for treating the vocal injuries of superstars. Julie Andrews, Sam Smith, Steven Tyler and
Keith Urban have passed through Zeitels’ clinic because of a breakthrough he made around the turn of the century.
Adele performs at the the 28th Annual MTV Video Music
Awards in Los Angeles. Photo by Kevin Mazur/via Getty Images
“Through much of the 20th century, people were brought to the operating room for little lesions, masses and polyps, and
things were removed with little hand instruments,” Zeitels said. “What’s happened in the last four decades, and even more
so in the last decade, is highly sophisticated laser technology.”
He said a century ago doctors had their patients swallow nitric acid to burn away cysts, polyps or nodules. Needless to
say, that wasn’t great because it often burned the vocal cord tissue too.
Normal female vocal cords recorded with a stroboscope, which slows down the apparent motion.
Female vocal cords open and close (phonate) 200 times per second, on average, while male cords move slower 100 times per second.
Slower vibration equals lower pitch and deeper voices. Professional singers’ vocal cords move faster than normal. Zeitels
said Steven Tyler’s vocal cords, for instance, vibrate at 170 times per second. Image by James Thomas/YouTube/Creative Commons
Surgery replaced this acid wash, but a windpipe is a small workspace. If a doctor struggled to patch an incision, then
it may bleed and scar. Large scars reduce the vocal cord’s flexibility and change a person’s pitch, which would be detrimental
So Zeitels and other laryngeal surgeons spent
decades finding a new way. His team now uses microsurgery to slice away the little masses, but the real kicker comes with their lasers. The heat from those light beams seal the wound before its busted blood vessels
can leak everywhere and cause a scar. Zeitels’ laser technique prevents those scars from forming.
“It was a perfect technique to solve the bleeding problems that both Sam Smith and Adele were having,” Zeitels said.
Call your grandma. It’s time you had a talk.
Vocal cord injuries are not an infliction of the young or old, Zeitels said, but rather they happen among those who are
fundamentally committed to using their voice. This habit is prevalent in modern society. Most jobs at the beginning of the
20th century involved manual labor and little voice usage, he said. But these days, the trend has flipped, and most gigs involve
regular talking. Voice recognition technology — think Amazon’s Alexa — is rapidly improving, which may further
shift the balance toward vocal communication.
So what can people do to protect their voices? Well, you can skip the hot tea.
“There’s this myth among singers that if you drink hot lemon tea, that’s going to help because the vocal folds gets bathed
in the tea,” Thibeault said “That’s completely false, because the tea doesn’t even come close to touching your vocal folds.”
The larnyx is protected from liquids by the epiglottis, a flap of cartilage the end of the tongue that covers the voicebox
every time you swallow. “You don’t want things to touch your vocal folds, because that causes you to cough — that’s
the sense of food going down the wrong pipe,” Thibeault said.
The warmth likely creates a placebo effect, whereby the drinker assumes something is happening, she said, even though the
temperature changes in the throat are minimal. At best, the tea can hydrated a chapped mouth or boost your body’s water
levels overall. The latter might aid hydration of your vocal cords, but the change isn’t immediate, Thibeault said.
No, the only remedy for a hoarse voice is taking a break. Because the vocal folds lack pain receptors, the only way to
sense their weariness is when your voice feels hoarse. Avoiding strain — excessive screaming — in the first place
is key, Johns said. But once the vocal cords are hoarse, then the sole mode of recovery is rest or frequent breaks. This rule
applies to the average Jane yelling on a sidewalk and the rock superstar.
Protesters calling for massive economic and political changes to curb the effects
of global warming hold a sit in around the Wall Street Bull statue on Broadway in 2014 in New York City. Photo by Andrew Burton/Getty
“If I went out and ran a marathon I’d injure myself, right?,” Johns said. “But if I trained, and I gave myself periods
of rest during my training, then I would be able to grow my vocal stamina.”
This stamina helps, but even professional singers can push too far. Adele, for instance, said if she
ever tried a 200-date tour again, then her injury would return. Yet with the proper rest and training, singers can maintain
their regular voice for decades. Opera singer Luciano Pavarotti performed well into his 70s.
But if you can’t work on your voice for hours everyday, then it’ll likely change as you age. Yes, your voice keeps evolving
even after puberty. Male voices get higher pitched, as their vocal folds lose muscle mass and stiffen with old age. Meanwhile,
female voices get lower from their 20s through their 70s, thanks to hormones.
The same thing happens when women have their periods. Testosterone levels increase, and a woman’s
pitch tends to drop.
“Many women report change in the voice through menopause,” Johns said, which is most likely due to testosterone. Throughout
most of a woman’s adult life, her ovaries secrete estrogen and progesterone, which dictate her sexual features and menstrual
cycle. But a woman’s ovaries produce small levels of testosterone too.
During menopause, estrogen and progesterone levels drop, but testosterone remains steady. The relative imbalance, Johns
said, likely thickens the vocal cord muscles and lowers a woman’s pitch. The same thing happens when women have their periods.
Testosterone levels increase, and a woman’s pitch tends to drop.
“Once women reach about 80, the effects of volume and muscle loss in the vocal folds kind of takes over and pitch rises,”
Singing and vocal activities can battle age-related voice problems, but regular conversation can help too.
“As we get older, people can be more isolated, and maybe using their voice less because they may not be working as much,”
Johns said. “It’s a use it or lose it type situation.”
Or, to put it simply, he said: Call your grandparents.
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cheer or jeer at inauguration? Here’s how to care for your voice appeared first on PBS