Losing your voice is frustrating as the ability to speak is vital for communication. Voice loss is often referred to as hoarseness, an all-encompassing term that includes voice breaks, a lower than-normal pitch, inability to hit the high notes (for singers), increased effort while speaking, inability to project one’s voice, early-onset voice fatigue and pain when speaking.

The most common cause of hoarseness is voice misuse and abuse. This arises from prolonged talking, shouting, inadequate hydration, insufficient voice rest and persistent coughing. The problem is prevalent among teachers, army personnel, lawyers and bankers. Misuse of the voice could also lead to vocal cord lesions which include vocal nodules, polyps, cysts and oedema.

Other causes of voice injury include the regurgitation of acid from the stomach (acid reflux) and nasal congestion from nasal allergies and sinus infections. Acid reflux causes inflammation of the vocal cords and the production of excessive throat phlegm. This leads to persistent throat clearing and cough, which can injure the vocal cords.

A congested nose will affect the resonance and voice projection, leading to excessive neck tension during voice production and consequent vocal cord injury. Hoarseness often accompanies a common cold. Our vocal cords become inflamed (acute laryngitis), and an accompanying cough and blocked nose aggravate the problem. Long-term smoking and frequent alcohol ingestion increase the risk of developing vocal cord cancer. These patients will have progressive hoarseness. Sometimes, breathing is also difficult and noisy.

Although less common, vocal cord paralysis occurs after cancer, surgery or accidents. This causes the voice to be weak and breathy. The most common way we abuse our voice is through constant throat clearing or coughing. Whispering is another way we injure our voice without realising it. Whispering causes muscle tension in our voicebox, leading to further injury.