Have you ever lost the use of your voice, maybe after a long period of coughing/flu, or after a late night out clubbing when you spoke for hours over loud music? If so, you are not alone. In most cases, the voice returns to normal within a couple of days, but for some people, the problem may continue, affecting their ability to speak easily.

Voice problems can arise from certain medical conditions, or be caused by the way a person uses his or her voice.
When people say they’ve lost their voice, they usually mean that the sound of their voice has changed or that the voice doesn’t come out as easily. The voice may sound hoarse, lower or higher in pitch than usual, or even disappear occasionally during a sentence.

People who have lost their voice may experience strain and effort when producing and projecting the voice, or tightness in the throat. Some may feel out of breath when talking. 
As losing one’s voice can be quite disruptive to one’s daily living and work, let’s examine the most common factors that may cause voice changes.

What could cause you to lose your voice

         LIFESTYLE AND VOCAL DEMAND

    On average, the vocal folds of an adult male vibrate about 120 times per second. Interestingly, this frequency is roughly doubled in adult female speakers. Imagine the number of cycles of vibration that happens when you talk continuously for hours! Due to professional, personal or recreational activities, some people place a heavy strain on their vocal fold muscles. Loud, intensive speech, or long sessions of singing all take their toll.

    Insufficient hydration may also reduce the efficiency of vibrations and increase throat irritation. Noisy or polluted environments as well as smoking can also lead to excessive vocal strain and irritation of the vocal fold tissue.

    Vocal MISUSE OR ABUSE

    Vocal misuse or abuse is the use of the voice in ways which can cause vocal fold injury. Some examples include:

    ​Vocal abuse
    		​Vocal misuse
    ​Shouting or screaming
    		​Speaking too loudly
    ​Speaking forcefully with excess tension
    		​Speaking with an unnatural pitch
    ​Talking for long periods without voice rest
    		​Talking over background noise
    ​Constant coughing, throat clearing
    		​Speaking without proper breath support
    ​Changing the voice to sound more authoritative

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    These patterns of voice use can lead to significant injury to the vocal folds. Imagine the vocal folds as your hands - in order to voice, these “hands” have to clap. If you clap your hands hard, they may start to hurt and you may experience some redness and irritation. If you continue this hard clapping, you might get swelling on your hands.
    Likewise, when the vocal cords come together in a hard and forceful way, some benign growths might develop on your vocal folds. These can affect the quality of your voice.
         Stress and emotion

    Our tone of voice conveys our emotions. During periods of extreme stress, negative feelings are sometimes expressed through shouting, screaming and other behaviours that may cause injury to the vocal folds.

    Other speakers may react to stress by “holding back” and not expressing their feelings. This may lead to a build-up of tension around the voice box. So, even in the absence of excessive voice use, voice production can be impaired.

    Medical factors

    Reflux disease refers to the flow of acid from the stomach to the food pipe and even to the throat/ voice box. This can cause swelling and irritation to the vocal fold tissue, altering the voice quality. 

    Other medical disorders that affect the respiratory system or the larynx may also result in voice problems. A common example would be an inflammation of the voice box/larynx, otherwise known as laryngitis.

    Throat cancer can also affect the voice and requires immediate medical attention. When cancer attacks the vocal folds, voice quality deteriorates due to the changes in the movement of the folds. Voice quality may become hoarse or raspy.

When assessing the voice, it is important to consider the interaction between all these factors. A unique combination of factors is at play in each individual presenting with a voice problem.

You should consult an otolaryngologist (ear, nose and throat doctor) should there be persistent hoarseness or change in the voice for longer than four weeks. Prompt attention to voice changes can help facilitate early diagnosis and subsequent early treatment of voice problems. The doctors may refer you to Speech Therapy if there is a need.

You may also click on the links of the SingHealth Speech Therapy Departments with the relevant services to find out more or obtain contact details:  

Changi General Hospital (CGH) 

Sengkang General Hospital (SKH) 

Singapore General Hospital (SGH)

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