Voice Therapy Service

You may have been referred because you have one or more of these symptoms:

• Discomfort or sensitivity in your throat (tight, achy or sore)
• Changes in your voice (croaky, strained, weak or whispery)
• Difficulty changing pitch
• Reduced volume or weaker voice quality
• Voice varies day to day or gets worse with prolonged use
• Feeling effort or strain to produce your voice
• An irritable dry cough or feeling of a lump in your throat (globus)
• Episodes of throat spasm.

The larynx (voice box) is in your neck, above the windpipe (trachea) and in front of the gullet (oesophagus).

The windpipe is the tube that carries air to and from your lungs. The gullet is the tube food goes down when you eat.

Inside the larynx are two vocal cords which are responsible for creating sound.

How it works when you breathe:

When you breathe in and out, air passes through your open vocal cords. The air moves freely between your lungs and your throat.

How your voice is made:

When you speak, your vocal cords close together and vibrate as air passes through them. These vibrations make the sound of your voice. The sound is shaped by your throat, mouth, and nose – this makes it louder and gives it tone. Your throat, tongue and lips work together to form the words you say.

Voice problems often happen because your vocal cords are not vibrating properly. If you have a chronic cough, feel like something is stuck in your throat, or have spasms that make your voice and breathing feel restricted, your voice box (larynx) may be irritated or hypersensitive.

These issues can happen for many reasons. If you were referred to us by the Ear Nose and Throat (ENT) team, they will have looked at your larynx and vocal cords and found an issue which hopefully can be improved by following advice from Speech and Language Therapy (SLT).

Drink plenty of fluids

If the vocal cords are dehydrated, they become dry and sticky, which reduces their ability to vibrate effectively. This can also cause irritation or a feeling of having something stuck in the back of the throat. It can take up to four hours for fluids to reach your vocal cords, so drink regularly throughout the day.

Limit caffeine and alcohol – particularly spirits

These can dry out the vocal cords. Choose decaffeinated versions of your favourite tea and coffee brands.

Inhale steam

Use a cup or a bowl. Breathe in steam through your mouth for approximately five  minutes every day. This soothes the voice box (larynx) and may reduce catarrh/mucus. Do not add anything to the water, products which contain menthol can add to the irritation.

Rest your voice

Plan regular times in your day when you can rest your voice. It is useful even if you can only spare 10-15 minutes at a time.

Do not shout or whisper

You may be tempted to alter your voice if it doesn’t feel like it is working effectively. However, raising your voice, shouting and whispering all add additional strain.

Reduce stress or tension

Stress and anxiety can affect your voice. Attempt to reduce this where possible by seeking support or prioritising activities which help you relax.

Do not smoke

The chemicals in smoke irritate the delicate vocal cords and can cause them to become inflamed.

Avoid noisy environments

Reduce background noise and speaker/listener distance where possible. Ensure you are face-to-face when talking.

Avoid smoky, dusty, dry atmospheres and exposure to irritants

Take regular sips of water to stay hydrated when in dry environments and clear any irritants. This can include places which use air conditioning or central heating. Also see our information on ‘cough triggers’.

A chronic cough is a cough that keeps coming back or will not go away and has lasted for more than 8 weeks. It can be annoying and tiring for you and those around you. The following advice is for improving a non-productive cough.

What is a productive cough?

Brings up phlegm, saliva or mis-swallowed food and drink from the airway so you can breathe easily.

What is a non-productive cough?

Feels like something is in your throat but nothing comes up. Often associated with a dry, tickly or irritated feeling. Can make your throat sore and may keep going even when you no longer need to cough.

Coughing when you don’t need to irritates your voice box. This can start a ‘vicious circle’ of coughing and irritation that may lead to:

• choking, retching, or vomiting
• sore throat or chest
• hoarse, rough, or lower-pitched voice
• tiny blood vessels breaking or vocal nodules forming.

Cough triggers

• Cold air: Breathe through your nose or cover your mouth and nose with a scarf.
• Exercise: Breathe in rhythm through your nose as you move.
• Pollen or dust: Use a scarf or mask.
• Sprays or strong cleaning smells: Avoid them or cover your mouth and nose.
• Dryness (heating, allergies, medication): Sip water often, use steam and limit caffeine.
• Colds and flu: Keep well hydrated.
• Asthma, bronchitis, or COPD: Take inhalers as advised by your doctor.
• Some medicines: Blood pressure, heart, or asthma medicines can cause dry cough or hoarseness – check with your GP.
• Reflux (acid coming up from the stomach): Especially at night. See ‘Managing acid reflux’ for more information.

Tip: Knowing what triggers your cough can help you avoid it.

Ways to reduce coughing

• Swallow hard several times.
• If you need to cough, do it softly to avoid straining your throat.
• Sniff in quickly 2–3 times through your nose, then blow out slowly through pursed lips.
• Breathe in through a straw, then gently blow out, or say ‘ssss’.
• Take a small sip of water once your throat feels calmer.
• Try slow panting with your tongue out.
• Suck an ice cube or sip very cold water before coughing starts.
• If you have asthma, your inhaler may reduce the urge to cough – ask your GP.

Keep practising

• Practice these techniques even when you are not coughing.
• Keep working at suppressing each cough – this helps break the cycle.
• Talk to your GP if you think your medicine is causing your cough, or if you might have reflux that needs treatment.

Reflux happens when stomach contents come back up into the oesophagus and sometimes into the pharynx (throat) and/or larynx (voice box). These areas aren’t used to the acidic content of stomach fluid, so can become irritated and inflamed. You may not be aware that you have reflux. As it doesn’t always cause obvious symptoms like heartburn. This is known as silent reflux. Speech and Language Therapy can advise on lifestyle changes, and your GP can discuss medical management.

Common symptoms of reflux

• Globus: The sensation of a lump in the throat when there is no physical lump.
• Hoarse or croaky voice.
• Trouble swallowing tablets or hard foods – sensation of food sticking in the throat.
• Frequent throat clearing or ongoing chronic cough.
• Dry, sore throat.
• Frequent burping.
• Taste of acid at the back of the throat.

To reduce the effects of reflux:

• Avoid eating late at night; leave a few hours before bedtime.
• Raise the head of your bed – use extra pillows if comfortable.
• Take prescribed reflux medication before your evening meal rather than in the morning.
• If using Gaviscon Advance liquid, take after eating, especially your evening meal.
• Some foods may trigger excess acid production, e.g. spicy foods, tomatoes, high fat content foods (pastry, curry, biscuits, cheese).
• Fizzy drinks, caffeine, citrus juices and alcohol may cause reflux.
• Reducing pressure on your stomach can help to manage reflux. Wear loose-waisted clothing, bend at the knees and lose weight if needed.

Too much muscle tension in the voice box (larynx) can affect how the vocal cords vibrate, changing how your voice sounds. It can also cause throat discomfort, such as aching, tightness or the feeling of a lump in your throat when there is none. 

Causes of excess tension include:

• Cold or flu – throat irritation, excess phlegm, coughing.
• Excess use of the voice – either habitually (for a long period of time), such as teaching, or suddenly, such as shouting at a football match
• Emotional stress. The nerves controlling the voice box (larynx) are linked to the body’s ‘fight or flight’ response. Emotional stress can tighten the muscles of the larynx and breathing may be affected. It may be that there is ongoing stress in your life, or something that happened as a stressful event. This muscle tension may remain even after the stressful event or trigger has passed.

If you’re struggling with emotional stress, anxiety, depression or low mood, think about:

• Can you make changes in your life to reduce stress and increase relaxation?
• Do you need counselling or extra support for how you are feeling?

If you feel you need help, speak to your GP or another healthcare professional. In Gloucestershire, NHS Talking Therapies offers free counselling. You can self-refer on their website (see link at the bottom of this webpage) or by calling 0800 073 2200.

Mouth and jaw

• Chew in a relaxed manner with your mouth open. Move your tongue around as you chew. Do this for one minute, then relax.
• Keep lips lightly together. Attempt a yawn and feel the back of your jaw open.

Tongue

• Run your tongue around all your teeth (top and bottom, front and back), as if cleaning them. Do this for one minute.
• Place your tongue just below your lower lip. Count to 10, saying each number on a separate breath.

Back of mouth and throat

• For a sense of a widening/opening in the back of your mouth and throat, imagine a pleasant surprise – for example, you go to a party and see a good friend you hadn’t expected to be there. Aim to produce a slow silent intake of air through a wide-open mouth and throat.
• Take a breath in. With mouth wide open and tongue relaxed, exhale silently. Then take a long, slow sniff in.

Tension held in the large neck and shoulder muscles can affect the smaller muscles that help your vocal cords work. Take time to complete some relaxation exercises and think about maintaining good body posture. Try to move around if you sit or stand in the same positions for long periods.

These exercises are designed to help release the ‘triangle of tension’, linked to voice problems and/or globus. Exercises should be gentle. Stop if you feel pain. Build up so that you can manage each exercise about five times.

Shoulder shrugs

Raise your shoulders to your ears. Hold briefly. Let them drop. Keep your neck and shoulders relaxed.

Arm swings

Swing your arms forward and cross them, keeping elbows at should height. Feel the stretch across your shoulder blades. Then swing arms back and out, feeling the squeeze in your shoulder blades.

Head tilts

Slowly tilt your head toward your left shoulder. Return your head to centre. Tilt your head toward your right shoulder. Make sure you keep your shoulders relaxed throughout.

Head rolls

Drop your chin to your chest. Slowly roll your head in a half-circle toward your right shoulder (right ear reaching toward shoulder). Keep shoulders relaxed. Roll your head back to chin position and repeat to the left side.

Shoulder rotations

Rotate the shoulders forwards five times, then back five times.