Q: Who is more likely to develop a voice problem?

• Zangers (professioneel of in amateurkoren) • Actors • Radio and television presenters • Teachers • Animators • Politicians • Representatives • Merchants • Telephonists

Question 1

When is it really a voice problem?

Accepted Answer

If you suffer from:
 • A weak voice
 • Pain when you use your voice
 • A cracking voice
 • Difficulty controlling your breath
 • Your speaking tone changes (high outlier)
 • A dry throat
 • A powerless voice
 • Hoarseness

Question 2

Who is more likely to develop a voice problem?

Accepted Answer

• ​​​​​Zangers (professioneel of in amateurkoren) 
 • Actors
 • Radio and television presenters
 • Teachers
 • Animators
 • Politicians
 • Representatives
 • Merchants
 • Telephonists

Question 3

When should I seek help for my voice problem?

Accepted Answer

Contact a doctor if:
 • your hoarseness or voice problem persists for more than three weeks
 • you have difficulty swallowing or shortness of breath
Make an appointment(javascript:void(0))

Question 4

Will medication or the intake of other substances affect my voice?

Accepted Answer

​​​​​De volgende factoren kunnen onder andere stemproblemen cause:
 • Smoking (active or passive)
 • Drugs
 • Aspirin and other blood-thinning medication
 • Alcohol or other inactive substances
 • Medication with a dehydrating effect (eg sleeping pills, nerve medication, etc.)

Question 5

Can smoking affect my voice?

Accepted Answer

Yes, smoking can certainly affect the voice. It reduces the voice quality.
 
These are common causes:
 • May increase reflux
 • Can increase the need to cough or cough and thus make your voice worse
 • Smoking also causes lung failure. Without proper breathing, controlled by the lungs, singing is impossible and speaking can become difficult
 • Smoker's polyps can form and/or cancer can develop on the vocal cords

Question 6

Can stomach acid affect my voice?

Accepted Answer

Yes, stomach acid can irritate the throat (larynx) and adversely affect your voice quality. This condition is called laryngo-pharyngeal reflux. This disease can be prevented by changing the time, type and amount of food you eat and by avoiding alcohol and caffeine. It also helps to place your head 30° higher at night by placing a block under the legs of the head end of your bed.

Question 7

Is drinking water good for my voice? How much should I drink?

Accepted Answer

Drinking enough water is good for your voice. The vocal cords vibrate 100 to 400 times per second and require constant moistening. Avoid drinking drinks that contain caffeine such as cola, tea and coffee. If you do drink such drinks, it is best to drink supplemental water. The recommended amount of water is 6-8 glasses/day.

Question 8

What are vocal cord nodules?

Accepted Answer

Vocal cord nodules are small calluses on the vocal cords. They occur in both boys and girls, but especially in the female sex.
 
Vocal cord nodules are caused by:
 • Voice abuse in the form of shouting, shouting and whispering
 • Using your voice incorrectly
 • Singing loudly or singing wrong
 • Unnatural speaking pitch

Question 9

Can voice problems be caused by cancer?

Accepted Answer

One can develop a cancer in the larynx. This can also occur on the vocal cords. Smoking significantly increases the risk of developing cancer. Alcohol and certainly the combination of smoking and alcohol consumption also have a detrimental effect on the voice and promote the development of cancer.

Question 10

What is Voice Therapy?

Accepted Answer

Voice therapy is an individual treatment method that focuses on changing the vocal behavior that can cause voice disorders or prevent normal use of the voice.
 
Voice therapy includes the following:
 • Indirect therapy (e.g. gaining insight into voice rest and vocal hygiene)
 • Direct voice therapy (e.g. postural adjustments, resonance exercises, voice placement, specific voice exercises or specific methods such as nasalation)
 • Voice coaching (e.g. voice optimization, presentation techniques, singing techniques)

Question 11

How long should I follow voice therapy?

Accepted Answer

The ENT doctor usually prescribes 6 months of speech therapy with an interim evaluation at the ENT doctor after 3 months. Depending on the progress you make and the clinical findings, further policy will be discussed in consultation with the doctor and speech therapist.

Question 12

With whom should I follow voice therapy?

Accepted Answer

Voice therapy is given by a speech therapist. It is best that this person is specialized in the treatment of voice problems (voice therapist). 
 
A list of speech therapists who specialize in the treatment of voice problems is available at the voice clinic. You can make a choice based on this list.

Question 13

Is surgery indicated for my voice problem?

Accepted Answer

​​​​​_d04a07d8-9cd1-3239-9149 -20813d6c673b_For some voice problems such as vocal cord paralysis, vocal cord nodules, polyps, cysts, etc., surgery is indicated and can solve your voice problem. 
If you need to undergo surgery, it is always recommended to follow speech therapy. Speech therapy is aimed at preventing vocal cord nodules or other syndromes from recurring.

Question 14

Are singers or professional voice users more likely to have a voice problem?

Accepted Answer

Just as a sportsman is more likely to sustain muscle injuries, the larynx (the speaking organ) of a singer or wordsmith is exposed to a higher risk of a voice problem. Many diagnostic and treatment procedures for performers with high-risk voices are similar to those used for more common voice abusers. However, these techniques have improved and become more organized in recent years. However, certain procedures are more specific to the 'high risk' group and the training and vocal hygiene measures are more refined and adapted. For example, we can consider the 'high risk' group of singers and actors as the 'Olympic athletes' of the professional voice users with pronounced demands and voice expectations in which the diagnostic and therapeutic methods must be applied to the utmost.
Every voice problem, especially with a professional voice user, should be seen as a unique diagnostic puzzle. Vocal problems in singers or actors can be manifested by a complaint (e.g. increased wild air, increased day-to-day variability) or by limitations of the voice (e.g. loss of high tones, difficulty singing high and low, having to make more effort when singing or acting, decreased stamina). The problem usually occurs when more is asked of the voice, so few have problems with the normal speaking voice.
A specialized voice examination can determine the cause. It goes without saying that finding out about this is an absolute condition before the best treatment can be discussed. A voice examination should be carried out by a phoniatrist (this is an ear nose and throat doctor with special competence in the study of voice), together with a voice therapist or speech therapist. The onset of the problem is discussed. An attempt is made to identify possible influencing factors. The seriousness of the complaints is checked, as is the motivation for rehabilitation. Subsequently, via auditory perception analysis, the singing voice possibilities and limitations are checked, such as the maximum vocal range, loudness possibilities, control possibilities, maximum phonation time, etc. The vocal apparatus itself is examined visually by means of a strobolaryngoscopy. During voting, the vocal cords are viewed in their full function. With a special lighting technique (stroboscopy) the moving vocal cords are displayed in a delayed phase so that even very small underlying imperfections or deviations can be detected. 
The voice is then recorded in a voice lab and objective voice parameters can be checked through certain voice exercises.
The above findings are all discussed afterwards and instructions are given for treatment options.
Recommended reading:
 • Bastian RW. Vocal fold microsurgery in singers. JVoice. 1996;4:389-404.(https://www.ncbi.nlm.nih.gov/pubmed/8943143)
 • Ingram DB, Lehman JJ. Management of high-risk performers in clinical practice. Current Opinion in Otolaryngology & Head and neck Surgery. 2000; 8: 143-152.(https://journals.lww.com/co-otolaryngology/Abstract/2000/06000/Management_of_high_risk_performers_in_clinical.3.aspx)

Question 15

What are the guidelines for good vocal hygiene?

Accepted Answer

1. Avoid caffeinated drinks: Try to limit or avoid the intake of coffee, cola, tea. Drinking as much water as possible is recommended.
2. Hydration: Drink plenty of water! Inhalation of vapor (vapours) is recommended. Heat a pot of water on the stove, put the contents in a bowl and lean over the bowl to inhale the steam. Place a towel over the head so that the steam can go directly to the face. Repeat this 3-4 times a day.
3. Rest and (wrong) sleep patterns: General fatigue due to lack of rest or sufficient sleep affects the voice. Sufficient sleep is therefore important. When tired, the voice sounds less powerful, slightly higher and more unstable. Sufficient (voice) rest is most appropriate here.
4. Upper respiratory infections: Avoid speaking with a hoarse voice during an infection. Try to apply as much rest as possible.
5. Reflux: If you suffer from reflux, it is important to limit fatty foods, stimulating foods, alcohol and smoking as much as possible.
6. Smoking and alcohol: Smoking causes inflammation and swelling of the lining of the larynx and airways. Smoking cessation is absolutely recommended. Also pay attention to the use of alcohol, as alcohol can lead to a dryness of the mucous membranes of the voice, but also to voice abuse.
7. Voice behaviour: Speaking in a soft voice is desirable. Try not to force yourself when you speak. You can use voice pauses and limit the speaking time on the telephone. Loud shouting, screaming, screaming, but also whispering is not recommended. Attract attention with a whistle, bell, …
8. Voice behaviour: Clearing the throat (=clearing the throat)/coughing, … should also be avoided. Instead of clearing your throat, try taking a dry swallow, taking a sip of water, coughing softly, humming or sighing softly.
9. Avoid speaking in a noisy environment.
10. Avoid speaking in a very dry environment. If the air is too dry (e.g. classroom where chalk is used, …) the mucous membranes of the larynx are stimulated much more quickly. It is also interesting to place a pot of water on your heating during the winter, possibly containing a few drops of eucalyptus.

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