Your Vocal Cords Hate the Pandemic, Too

Masks, distancing, and remote meetings can protect overall health, but they are rough on the voice

If you’ve found yourself doing a lot of yelling during the pandemic, you’re not alone. The new reality of social distancing, wearing masks, and communicating through video platforms has forced many of us to change how we use our voices — and it’s not looking good for our vocal health. Complaints about hoarseness and a rough throat are on the rise, and laryngologists have noted growing numbers of patients seeking care for voice-related issues.

The greater vocal effort required during this pandemic, both from mask-wearing and video calls, explains why many people experience vocal strain, says Lee Michael Akst, MD, director of the Johns Hopkins Voice Center. It’s difficult to judge volume over computer screens during video calls, so people often speak much louder than necessary, he adds. Back-to-back work meetings followed by virtual hangouts with friends also can lead to voice overuse.

Just as overuse can injure our joints, we can damage our vocal cords when we work them too hard.

Interacting with people in person isn’t the usual walk in the park for the vocal cords, either. Face masks dampen sounds and muffle the voice, so we speak with greater intensity just to be heard over the mask and from six feet away. The masking of visual communication cues, like facial expressions and lip-reading, doesn’t help.

This prolonged daily effort leads to strain. We produce voice when the vocal cords vibrate rapidly inside the larynx (also known as the voice box) as air passes through them. Just as overuse can injure our joints, we can damage our vocal cords when we work them too hard.

“With prolonged or intense voice use, the extremely rapid collisional forces from the vibrations can be traumatic to the vocal cords, resulting in swelling or stiffness,” says Michael Lerner, MD, an assistant professor of otolaryngology at the Yale University School of Medicine. Stiff or swollen vocal cords just don’t vibrate as readily, which manifests as hoarseness, also known as dysphonia. “I suspect that many of the patients I am seeing now were able to ‘get by’ vocally before the pandemic, but the new vocal challenges simply pushed them over the edge,” Lerner says.

Poor posture and inadequate hydration also negatively affect the vocal cords, says Sarah Louise Blumhardt, MS, CCC-SLP, a speech-language pathologist at the Baylor College of Medicine Institute for Voice and Swallowing. Slouching limits the flexibility of respiratory muscles and doesn’t allow the lungs to fully inflate, which affects breathing and speaking. Akst says that dehydration also factors in because vocal cords need to be lubricated for them to vibrate against each other.

People who have had Covid-19 may experience vocal problems, too. The disease doesn’t directly affect the larynx, but the shortness of breath can reduce voice quality, says Akst. Further, he says, “anyone who has required intubation and mechanical ventilation may be at risk of laryngeal scar from the tubes themselves, leading to reduced voice box function.”

Chronic stress from the pandemic can be another factor because it leads to muscle tension that settles in the neck area. “I have recently been seeing more patients with hoarseness resulting from tension affecting the larynx and the muscles in the front of the neck, which we call muscle tension dysphonia,” Lerner says.

If you try to speak when you’re already hoarse, you may end up exerting more vocal effort to compensate. But the repeated trauma of increasing the vocal load to overcome the speaking difficulty will only lead to further strain. This vicious cycle will continue unless you consciously avoid voice overuse. Without active measures, you can even develop vocal cord disorders.

A speech-language pathologist can use non-invasive voice therapy to treat most nodules and polyps, which are noncancerous growths on the vocal folds, says Lerner. If voice strain leads to other growths or vocal cord paralysis, then voice surgery by a laryngologist would be needed, he says.

To maintain vocal health and minimize further trauma to the vocal cords, these experts offer the following tips:

  • Stay hydrated. Drink enough water and maintain good hydration to keep vocal cords lubricated when they vibrate. To soothe them and keep them moist, you can take pectin-based lozenges or use a humidifier that eliminates dry air. Know that alcohol and caffeine can dry out the vocal folds and larynx as well, so be mindful of your consumption.
  • Modulate your voice. Try not to raise your voice more than needed. Lerner offers a vocal health tip: In virtual meetings, use a volume that can be heard an arm’s length away. In these meetings or in real-life encounters, you can also adjust your voice to communicate more effectively by emphasizing certain words, varying the tone or pitch, or speaking more slowly. Blumhardt recommends exaggerating your articulation of words so that others can understand you better without straining your voice.
  • Fix your posture. Working from home during the pandemic makes maintaining good posture a challenge, especially with makeshift home offices that aren’t ergonomically designed. Poor posture not only results in persistent neck, shoulder, and back pain, but also affects how you breathe. Sitting with your shoulders back can help with breath management and support, making it easier to produce sound.
  • Adjust your audio input volume. Most video chat platforms allow for manual adjustment of the input volume so that others can hear you more easily with less vocal effort on your part, says Lerner. Explore these settings and test them out. If you can, invest in a wired headset or quality microphone to support your voice even more.
  • Rest vocally, mentally, and physically. Pay attention to the sound of your voice and how speaking feels so that you can learn when you need to rest it. To avoid overusing the voice, Blumhardt recommends taking “vocal naps,” a vocal rest for 10 minutes of every hour of talking. Physical fatigue also plays a role, so frequent breaks and a good night’s sleep may offer benefits, too.
  • Seek professional help. Occasional hoarseness is normal and not uncommon with upper respiratory tract infections, says Akst. However, if you’ve experienced vocal strain for more than two weeks, experts recommend that you make an appointment at a voice center with a laryngologist and speech-language pathologist for an evaluation.

Vocal health recommendations are highly individualized, so what worked for others may not work for you. As a general rule, if your voice is already strained, it’s good to keep in mind that silence can be golden.

Health & culture writer with bylines in Insider, VeryWell, Architectural Digest, Elemental, and more. Twitter @elorisea

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