Swelling is one of the five universal signs of inflammation – says Dr. Anthony Jahn. If you are a singer suffering from hoarseness or voice loss, take the mystery (and misery) out of what is happening to you, by understanding these five facts about laryngitis.
HEALTH WARNING: No article is a substitute for a doctor. If you have experienced changes in your voice that last more than a couple of weeks, see your doctor and/or your ENT (ear nose and throat doctor) as soon as possible.
1. Inflammation is your body’s response to something
“Laryngitis” means inflammation – or irritation – of the larynx (voice box). “It involves the vocal folds and the structures above them,” says Dr. Anthony Jahn, ENT (ear nose and throat) doctor, prolific writer and expert on vocal health for singers.
Inflammation anywhere in the body, is your body’s response to something harmful.
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Upon hearing the term, “inflammation,” singers may wrongly assume that inflammation and swelling are the same thing.
However, swelling is a sign of inflammation. There are five universal signs of inflammation: impaired function, swelling, redness, pain and heat.
We singers generally focus on vocal fold swelling* and impaired function when evaluating our own laryngitis.
The other three signs of inflammation are difficult to detect (redness and heat) or difficult to localize (pain can be felt in the pharynx, but not the larynx/voicebox).
2. Laryngitis has many causes
Even though it completely messes up your vocal range for a few days or weeks, inflammation in your larynx is a good thing – believe it or not.
“In general, inflammation accomplishes two things,” says Dr. Jahn, “It brings more blood flow to the area to deal with bacteria or viruses, and it immobilizes the body part, taking it out of commission and allowing it to heal.”
Jahn also points out that inflammation for no reason is not helpful and should be treated.
“The commonest cause of hoarseness that we call laryngitis,” says Dr. Anthony Jahn, “is either an infection (usually viral) or excessive voice use.”
In other words, the causes of your laryngitis falls into one of two categories:
Something you picked up. Your larynx becomes inflamed as a response to a virus, bacteria, or other irritant that has entered your body. Run-of-the-mill viruses are not serious. However, things like bacterial throat infections can cause difficulty swallowing and breathing, and require immediate medical attention, according to Dr. Marcus Coneys, anaesthesiologist, pain specialist and musician.
Something you did (excessive voice use). In the case of the strenuous activity, says Coneys, “The cause of the inflammation is mechanical, or having to do with how the voice has been used.” Your larynx becomes inflamed as a way of immobilizing or protecting a part of the body that has been overused in some way so it can heal.
3. Laryngitis can be acute or chronic
Acute (or short-term) laryngitis, generally lasts two weeks or less. Acute laryngitis often develops in conjunction with other cold symptoms such as congestion, coughing, sore throat and fever, however, there may be no other symptoms, especially if excessive voice use is to blame.
Chronic laryngitis lasts three weeks or more, and will continue for as long as exposure to the offending irritant lasts. It can be caused by smoking, acid reflux, allergies, bacterial or fungal infection, chronic coughs or chronic misuse.
4. You must figure out what is behind your laryngitis, so you can heal
If you have symptoms of the common cold, or if you have experienced them in the past few days, such as congestion, sore throat, headaches etc., then any laryngitis you experience is likely a result of “something you picked up,” i.e. that cold virus.
Even once most of your cold symptoms have disappeared, it can take time to get back all the notes in your singing range, as swollen vocal cords can take time to return to normal, and residual tension can get in the way too.
What if you don’t have any signs of a virus?
Then you must examine your behaviour the 24 hours immediately before you noticed changes in your voice.
If you were straining, overloading or overusing your voice, then your laryngitis is likely a result of “something you did,” i.e. a strenuous activity.
Strenuous activities that can cause laryngitis:
Cheering for hours at a sports event
Talking over noise at a party
Talking or yelling angrily for extended periods
Straining to sing over a loud band when you can’t hear yourself
Really bad: If you have been practising 8 hours a day to learn new tunes for a gig while you are congested and hacking up a lung you are mixing excessive voice use WITH an illness which could cause a vocal fold injury.
5. The signs of laryngitis are lower range, hoarseness and delayed onsets
If your larynx is inflamed, that means your vocal cords (and the mucosa lining that covers them) are probably thicker than normal – they are swollen.
With this general swelling, your vocal range will be lower than normal, because, like the strings of a guitar, the thicker the cord, the lower the pitch. “The voice will feel noticeably lower,” says vocal coach, Michael O’Connor, though “for some girls, the voice may in fact sit higher than usual (like a croaky whisper) but it will have no power.”
Laryngitis causes a breathy or hoarse vocal tone and delayed vocal onsets, which are due to the swelling and stiffness of your irritated vocal folds.
“Because the vocal folds are unwieldy,” says Jahn, “they do not engage with the breath as easily at the onset of phonation.”
He goes on to say that more pressure and breath are needed to get your irritated folds to engage.
When you identify these signs of laryngitis, it’s time to cancel your social engagements, postpone your auditions and re-book your gigs for the next week or two. Hydrate, rest and give your larynx a chance to heal.
*There are other swellings that can occur on the vocal folds. In the case of acute laryngitis, the swelling is general and uniform over your whole larynx, whereas in the case of a polyp or nodule, there would be a clearly defined lump or bump on the vocal fold. “Nodules or polyps are not considered laryngitis,” Says Jahn, “but do cause hoarseness, the same as laryngitis, which accounts for some confusion.” See your doctor if changes in your voice persist for more than two weeks.
Dr. Anthony F. Jahn is an internationally renowned otolaryngologist based in Manhattan with a subspecialty interest in the professional voice. His practice includes classical and popular singers. He holds academic appointments at Columbia University and Westminster Choir College in Princeton, and is Medical Director at the Metropolitan Opera and Jazz at Lincoln Center.
Michael O’Connor (Potts) is a New Zealand tenor and voice teacher. He has trained under renowned soprano Dame Malvina Major. His vocal journey took a hiatus at 23 when he had to have surgery for reflux. He retrained using traditional Italian/Swedish methodology and has been performing ever since. Recent performances are: Tony (West Side Story), Piangi (Phantom of the Opera), and the Auckland gala. Find Michael’s articles on his website The Complete Singer’s Resource.
Singsician wishes to thank Dr. Marcus Coneys for educational support on medical concepts relating to this article. Dr. Marcus Coneys is an anaesthesiologist, pain clinician and musician in Alberta, Canada.