By Carly Schiff, MS, CCC-SLP
Most people take swallowing and vocalizing for granted — they are simply spontaneous activities that people do hundreds of times a day without giving them a second thought.
But with age, or as a result of a wide range of health conditions, the muscles used to swallow and vocalize, as well as the surrounding tissue, can weaken or become diseased. This can lead to hoarseness, discomfort, difficulty eating and drinking, or general communication challenges.
Changes in voice and swallowing can be an indication of anything from a simple seasonal allergy to cancer, as well as a range of conditions in between. That is why it is important to seek a medical evaluation for symptoms such as a vocal change that lasts more than two weeks or difficulty swallowing that impacts your quality of life.
Why is my voice hoarse?
Hoarseness is a symptom of a voice disorder that occurs when there is a problem with your vocal cords, also called vocal folds — the bands of smooth muscle tissue in your larynx that produce the sound of your voice.
In general, voice disorders are most commonly caused by:
• Prolonged trauma to the voice from talking too much, too loudly, or with bad technique. This can cause lesions such as nodules, polyps and cysts on the vocal cords. Teachers, courtroom attorneys, performers, or anyone who uses their voice heavily for a living are often at greatest risk.
• Neurological disease or conditions. People with Parkinson’s disease or those who suffered strokes may experience hoarseness and other voice problems. Other neurological conditions, such as multiple sclerosis, myasthenia gravis and ALS can also affect the voice.
• Aging. As you age, your vocal cords become thinner or bowed. These changes can cause hoarseness and decreased power in your voice as the thin vocal cords struggle to close fully during voicing.
Why am I having trouble swallowing?
Involving more than 10 pairs of muscles and many nerves, swallowing is a complicated process that occurs in four stages:
• Oral preparation, the stage when food and liquid is gathered and chewed in preparation for swallowing.
• Oral, the stage when the tongue pushes the food or liquid to the back of your mouth, starting the swallowing response.
• Pharyngeal, when the food or liquid is passed through your pharynx, throat and into the esophagus.
• Esophageal, when food or liquid passes through your esophagus and into your stomach.
If you are having trouble swallowing (dysphagia), the problem could be occurring during any one or a combination of these stages.
The most common and benign swallowing difficulties in the general population tend to be related to age-related muscle weakness. Additionally, those who undergo radiation treatment for head and neck cancer are at high risk of having dysphagia. There are many other causes of dysphagia as well.
When should I see a doctor?
See your doctor if you experience signs of a voice or swallowing disorder.
For a voice disorder, look for:
• Change in voice quality lasting more than two weeks.
• Throat discomfort when speaking.
• Difficulty projecting your voice or tiring when speaking.
• The urge to clear the throat or cough when speaking.
For a swallowing disorder, look for:
• Difficulty swallowing foods without excessive chewing or cutting into small pieces.
• The sensation of food getting stuck in your throat or chest.
• Coughing or choking when swallowing foods or liquids.
• A feeling of something “going down the wrong pipe” when swallowing.
Most swallowing and voice problems can be diagnosed with one of a few basic tests that are used to view your tongue, throat, larynx, and vocal cords, and to see how everything functions when you speak or swallow.
How does voice and swallowing therapy help?
Voice and swallowing therapy helps improve strength and function of the voice and swallowing muscles, similar to physical therapy.
If you are experiencing multiple swallowing problems, a speech language pathologist can teach you strategies for eating properly and specific exercises for strengthening your throat and improving coordination of the swallow.
For most voice disorders, a speech language pathologist will guide you through exercises to ensure that you are using your voice properly, including exercises to improve the coordination and flexibility of your vocal cords.
On average most voice therapy programs, which require a referral from a physician, involve five sessions over the course of two to three months. The length of swallowing programs depends on the cause of the condition. Once the sessions are completed, patients receive a home maintenance therapy program to promote continued improvement.
In some instances, voice or swallowing therapy may not be enough, and surgical intervention is needed. Following a surgical procedure, therapy may be recommended as part of the healing process.
Can voice and swallowing disorders be prevented?
When it comes to swallowing issues associated with aging, the best way to keep your swallow muscles strong is by using them. If you notice swallowing is getting more difficult, rather than simply avoiding swallowing tougher foods or taking smaller bites, discuss it with your doctor so treatment can be provided before the condition worsens.
To protect your vocal cords and help prevent voice disorders:
• Do not yell or shout.
• Avoid overusing your voice. Give it regular breaks throughout the day.
• Stay well hydrated.
• Follow a low-acid diet.
Anyone can experience a voice or swallowing problem at some point in their lives. Treatment, however, is often successful at improving the swallow function and giving you your voice back.
To find a physician affiliated with Penn Medicine Princeton Health, call 1-888-742-7496 or visit www.princetonhcs.org.
Carly Schiff, MS, CCC-SLP, is a speech language pathologist and director of voice and swallowing at Penn Medicine’s Becker ENT and Allergy.