The voice, what it reveals and what it suffers

More than just a sound or a means of communication, the voice is a marker of identity – one as unique as a fingerprint. Yet it is also fragile. It can falter, change or weaken, and, in rarer cases, disappear altogether, reminding us how essential it is to protect it.

At this point, it helps to take a closer look at the biology behind the voice. “We tend to think the voice is simply the result of the vocal cords vibrating,” explains Professor Nayla Matar, an ear, nose and throat specialist and expert in laryngology. “But the voice is far more complex than that. It is possible to produce a voice without vocal cords, and, conversely, to have vocal cords and yet no voice,” she continues. “The voice is the sound a person produces through the coordination of several elements: the lungs, which provide the airflow; the vocal cords, which create vibration; and everything above them – the tongue, the oral cavity, the sinuses and the lips – which shape and modify the sound generated at the level of the vocal cords.”

This means of communication changes at two key moments in life: during puberty, when the larynx grows rapidly, leading to changes in the size and composition of the vocal cords. “This voice mutation can be more challenging in boys,” Professor Matar notes.

The voice also changes with age. With weight loss or respiratory problems, it may become thinner in men and deeper in women, especially in smokers.

Two types of voice

Specialists distinguish between two types of voice: the speaking voice and the singing voice. The former includes both the conversational voice – used in everyday exchanges – and the projected voice, intended to address or persuade an audience (public speech or classroom setting). By contrast, the singing voice involves a more complex and technical dimension.

Beyond how it is produced and used, “the voice also transmits, unconsciously, information about the speaker: gender, age, emotional state, and more,” Professor Matar adds. “We form an impression of a person and their character simply by hearing their voice.”

Voice disorders

Like other parts of the body, the voice is not immune to disorders. These are typically divided into three main categories. “Functional dysphonia – or the improper use of the voice, such as constantly straining it, speaking loudly or as if under stress – is common,” she notes. “It is relatively easy to treat through speech therapy, but it requires the person to become aware of it.”

The second category includes benign conditions, mainly nodules, polyps and Reinke’s edema. “Nodules are small swellings on both vocal cords that occur among people who use their voice continuously, such as those teaching young children, and who end up misusing it because of fatigue and strain,” she adds. “Polyps tend to occur after intense vocal strain – such as shouting – and in people taking aspirin or other blood-thinning medications. Reinke’s edema – a build-up of gelatinous fluid in the vocal cords that causes them to thicken – often results in a deeper, more masculine-sounding voice in women who smoke.”

The third category includes malignant pathologies in the vocal cords and the larynx more globally. They are linked to tobacco use in all its forms.

While rates of this cancer are declining worldwide, they are unfortunately still rising in Lebanon.

Stress and reflux

Air pollution can also affect the vocal cords in more insidious ways, “as the mucus that helps lubricate them becomes less effective.” “People may then feel the need to clear their throat more frequently, as secretions become thicker,” she notes, adding that those with allergies tend to be more affected.

The same applies to reflux, a very common condition that can cause “direct irritation of the vocal cords – when acid reaches and affects them – and indirect irritation – when acid impacts the nerves responsible for vocal cord function.” “This is why reflux is so often implicated in dysphonia and other voice disorders,” Professor Matar points out. “Reflux itself is exacerbated by stress, which also plays a role, as we tend to use our muscles in a more strained and tense way when we are under stress.”

Seeking medical advice

When should a change in the voice be a cause for concern? “When it persists for more than two weeks,” Professor Matar replies. “In smokers, voice changes tend to develop gradually, and the individual may not notice them. It is often those around them who become aware of the change first. However, if the voice remains altered beyond that period, after a cold or any other viral infection, the vocal cords should be examined without delay to avoid unpleasant surprises. Medication does not solve the problem. On the contrary, it can create a false sense of security, whereas in cases of pathology, early diagnosis can be life changing.”

Professor Matar also stresses that speech therapy plays an essential role in managing voice disorders, as some conditions can be treated through simple rehabilitation alone, such as vocal cord nodules, which can heal in up to 80% of cases. “In addition, the speech therapist gives patients the tools to use their voice more effectively in daily life,” she adds. “Some conditions require a combined approach to treatment including surgery and voice rehabilitation.”

While there are no screening tests for early detection of voice disorders, an annual examination of the vocal cords is recommended for smokers. More broadly, simple habits can help preserve vocal health: avoiding extremely dry environments such as strong air conditioning or heating systems, refraining from shouting, staying well hydrated throughout the year, and preventing reflux. “But above all,” Professor Matar concludes, “what children must be taught from an early age – and what should be part of a national public health policy – is not to smoke.”