Vocal Strain--What Do I Do When My Voice Isn't Working?

This article appeared in The Soul of the American Actor, Volume 11 No. 2, in 2014.

Every performer knows what vocal strain feels like: that horrible feeling when you open your mouth and “somebody else’s” voice comes out. Our voices are so important to our identity as performers that we often freak out when it happens. However, while vocal strain is nothing to take lightly, remaining calm will help you find a more integrated physical coordination to remedy any current situation and prevent future problems. Keep calm and carry on. Vocal strain can appear as hoarseness, a lack of volume and intensity, or even a complete inability to make sound; it can appear as a feeling of tension or a “lump” in the throat; it can appear as dryness, as if our vocal folds had forgotten how to lubricate themselves. These are the physical sensations, the results, of straining your voice.  A properly produced voice feels easy and free, never pushed or forced. In voice, pain equals strain. When you find yourself working hard to create the volume or intensity you need, whether for a performance or in a noisy room, you can expect to feel vocal strain. Common causes of vocal strain include:

1. A physical condition (e.g., fatigue, coughing, dehydration, smoking, viruses, fungal or bacterial infections, chronic sinusitis, allergies, reflux, or GERD).
2. Using your voice when your vocal folds are swollen, whether from misuse or illness.
3. Misplaced tension in the body:
   1. holding in the throat or back of the neck;
   2. holding in the jaw and tongue;
   3. over-tightening and shortening the abdominals.
4. Using too much breath and breath pressure. Pressing and pushing the breath, creating too much pressure at the vocal folds:
   1. to create a louder or more intense sound;
   2. to create a character voice.
5. An improperly supported everyday speaking voice:
   1. using “vocal fry”;
   2. dropping breath support at the ends of phrases;
   3. not using proper support when speaking over loud sounds at restaurants, bars, concerts, or sporting events.

Vocal strain is the result of imbalance in the physical effort you are using to produce your voice. A properly produced voice feels “easy” because no muscle is working past its capacity: the physical effort is balanced. I often say that speaking and singing are easy... it’s learning to do it properly that can be hard! When we use the large, deep muscles of our body to support our sound, we don’t need to overwork the smaller muscles in the throat that create vocal strain. Recognizing your own patterns of misplaced muscle tension and overwork--particularly with regard to your breath--can help you not only to prevent vocal strain from happening, but also to help you recover more quickly even after you have strained your voice. When you experience vocal strain, there are several things you can--and should--do. 1. Rest your voice; rest your body.

When using your voice feels uncomfortable, that is a sign for you to take it as easy as possible. Keep quiet and give your vocal folds a chance to recover. When you use your voice, keep the effort level low. Don’t strain your voice further by trying to make a “normal” sound. Speak at whatever volume is most comfortable. Whispering is not recommended, because you will work very hard to make your whisper audible. Ease is the key!

2. Steam and irrigate your throat and sinuses. Hydration is very important for the recovery of the vocal folds.

Drinking liquids is helpful for overall hydration but not a substitute for steaming, which has a direct and immediate impact on your vocal folds. Teas, lozenges, and sprays can soothe your throat, but liquids do not pass through the vocal folds, so they are not directly affecting your folds.

Boil water, pour it into a bowl, let it cool off a bit, and then make a “tent” with a towel over your head and the bowl to breathe in the steam. Some physicians advise against using tap water and recommend distilled water or even prescribe a sterile solution used in surgeries. A long, hot shower is another easy way to inhale steam. When using humidifiers, facial steamers, and the like, be sure to use distilled water and clean them frequently to avoid any buildup of mold or bacteria.

Irrigating the sinuses with warm distilled water, a very mild saline solution, or a nasal spray without saline (such as Xlear) is a great everyday habit for people who use their voices, and can be particularly soothing when we experience vocal strain. If you use a neti pot for this purpose, be sure to sterilize it between uses. Or, you can “sniff” the water out of your own clean, cupped hand. If you use an over-the-counter nasal spray be sure to sterilize the applicator between uses.

3. Stretch and release your body, especially your throat, spine, and the spaces between your ribs, to facilitate better breathing habits. 

When our vocal folds are stiff or swollen, they do not respond as easily and quickly to the breath as they usually do. This is the first sign that we need to use them more gently, but most people do just the opposite. We tend to push and press the breath harder against the folds, trying to create our usual responsiveness and quality of voice. Release your voice; don’t force it. It can feel counterintuitive, but we must work less when our voices aren’t responsive. You don’t need a lot of air to make a healthy vocal sound; healthy vocal production requires a balance between the breath and the vocal folds. Stay away from any physical exercises or activities that shorten and tighten the throat, back of the neck, abdominal wall, or spine (no crunches, pushups, or any activity that may make you hold your breath). Massage and releasing bodywork are both therapeutic. 

4. Certain vocal exercises, done properly, are restorative.

First, gently yawn or sigh to feel release and stretching in your throat. Don’t push your throat open; relax it open. Then, make quiet sounds, almost like a whimper, on a comfortable pitch, using an “m,” “n,” “ng,” or “y” sound. Send a little air through the nose just before you start the sound. Try “gliding” through pitches in a comfortable range, like an easy hum through a sighing throat. Place your fingers on the bones at the bridge of the nose to make sure they are vibrating. Both your throat and breath should feel very free, not pressed or pushed. Think of the breath as a release, the throat as a sigh, and the sound as easy. Do these exercises throughout the day, in sessions of 4-5 minutes. You can find more release and breathing exercises on the website for my DVD, Voice at the Center. 

The former conventional wisdom was that complete vocal rest was the quickest way to relieve the swelling and hoarseness of vocal strain is inaccurate. Recent studies (published in papers such as “Vocal Exercise May Attenuate Acute Vocal Fold Inflammation” by Katherine Verdolini Abbott, et. al.) have shown that proper use of vocal exercises like the ones described above help restore your voice faster than vocal rest alone. Interestingly, the opera singer Lilli Lehmann understood and recommended this same type of vocal exercise for vocal strain in her book, How to Sing, written in 1902!  

5. Take care of your whole body. Vocal strain is the result of over-doing, so take some time to relax and create more balance in your energy.  

If your vocal strain does not respond to this treatment within a few days, if you experience pain, or if you remain hoarse for more than a week, you should seek the expertise of an ENT, an Ear-Nose-and-Throat doctor. There may be underlying causes that are preventing the vocal folds from responding to these treatments. Some physical issues that lead to vocal strain are viruses, fungal or bacterial infections, chronic sinusitis, allergies, reflux, or GERD. Over time, systematic abuse of the vocal folds can lead to polyps, nodules, and chronic edema or swelling.

Find a doctor who is used to working with the specific needs of performers. Have a complete examination, including a videostroboscopy. That might seem like overkill, but vocal folds are one to a customer! A small problem, caught early, may be easy to remedy. Left without treatment, however, that small problem can turn into a major issue. Experiencing vocal strain can be a daunting--even scary--experience, and any form of vocal strain should be seen as a wake-up call. But most vocal strain is caused by unfortunate habits of breathing and speaking, and habits can be changed.