Looking after your voice: irritants

The following are known to irritate the throat and voice box, leading to changes in the production and sound of the voice. If you are experiencing difficulties with your throat it can become oversensitive so a small degree of exposure to an irritant can cause you a problem.

It is important to try to minimise your contact with the following and especially avoid those irritants which you know cause you the most problems.

Medications

Many medications can affect your throat and/or the sound of your voice by causing inflammation and swelling of the vocal cords. Dryness of the throat and vocal cords is common as secretion production is reduced or the thickness of the secretions is increased. This can lead to tension and tightness of the muscles in your throat and voice box and coughing or throat clearing.

The common medicines which cause these problems include:

• Antihistamines
• Cough suppressants
• Anti-depressants
• Anti-hypertensives (for high blood pressure)
• Diuretics
• Sleeping tablets
• Anti-coagulants (blood thinners), including aspirin
• Treatment for neurological conditions
• Decongestants, including cold and flu remedies
• Inhaled corticosteroids (for asthma)
• Some forms of pain relief

Some of these medications, for example anti-hypertensives, anticholinergics, muscle relaxants and cough suppressants, can aggravate acid reflux by relaxing the muscles which prevent gastric acid refluxing into the throat.

You should not change or stop your medication without discussing with your doctor first. If you are required to take any of the medications above you should compensate for the effects by maximising your hydration and relieving dryness using ideas from the voice care sheet.

In addition try to limit your use of cold and flu remedies and decongestants and avoid using soluble aspirin to gargle with, as it increases the risk of haemorrhage of the vocal cords.

If taking inhaled corticosteroids for asthma ensure you rinse your mouth and gargle with water after using your medication. Steaming after using medication can also be beneficial.

Some herbal remedies may also affect the throat and voice.

Medicated throat pastilles or lozenges

The ingredients often contained in these products used to clear nose and sinus congestion, for example menthol and eucalyptus, irritate and dry the throat and voice box. They may also contain an antiseptic to numb any pain in the throat, which may lead you to strain your voice without realising the extent of effort being used and associated damage to your vocal folds.

Unless your doctor has prescribed these products, they are best avoided. Instead keep well hydrated and try sucking sugar-free boiled sweets.

Gastric reflux

Gastric reflux or heartburn can irritate the throat and voice box, leading to hoarseness and changes to secretions. Changes to diet and lifestyle can help alleviate symptoms.

You should discuss your symptoms with your doctor as they may be able to prescribe medication to help.

Smoking

Smoke will irritate the lining of your throat and voice box, which may lead to changes to the sound of your voice. You should try to stop, if you smoke and if you live with someone who smokes, try not to be present in the room whilst they are smoking or keep the room well ventilated.

It is best to try to avoid spending a long time in smoky places, but if you do, compensate for the effects of irritation and dryness using the ideas on the voice care sheet.

Dry atmospheres

Dry climates and environments can contribute to dehydration and aggravate dryness of the throat. For example central heating, air conditioning, travelling on aeroplanes and visiting countries with dry climates.

If you cannot avoid these environments you should compensate for the effects by keeping well hydrated or humidify the environment with humidifiers, houseplants, or bowls of water near hot radiators.

Dust

• If jour job or hobbies involve being in a dusty environment, you should wear a dust mask (available from DIY stores).
• At work, if masks are supplied, wear them. If they are not, speak to your Health and Safety representative or occupational health team.
• Many dusts are harmful to your health and can also irritate your throat.

Fumes

• If your work involves exposure to fumes, wear a suitable mask (contact Health & Safety or Occupational Health for advice).
• Perfume, felt tip pen fumes, chlorine, solvent based glues, paint, varnishes, bleach, and other cleaning products can contain strong chemical fumes. They can be found at home and in many work environments.
• Read the label of these products and follow advice on ventilation.

Spicy foods and dairy products

• These should be eaten in moderation. Raw foods, green leafy vegetables and water are good alternatives.
• Spicy/acidic foods may increase the likelihood of reflux which can irritate the throat and cause hoarseness. When eating spicy or acidic food, you should drink plenty of water.
• Dairy products can cause secretions to become thicker (for example increased mucous). You don’t need to stop taking dairy products as they are useful in providing our bodies with calcium, but if you take large amounts you may want to try lower fat alternatives. Drinking plenty of water and inhaling steam will help to compensate for thicker secretions.

Alcohol and caffeine

• Alcohol and caffeine can dehydrate you and can therefore dry out your throat.
• Dilute alcohol by having it with a mixer (such as juices or tonic water).
• Try not to take more than three cups of caffeinated drink per day (for example tea/coffee).
• Also try decaffeinated forms of tea, coffee, and cola drinks. Herbal teas are also a good alternative.

Throat clearing/ coughing

Some people with voice problems have developed a habit of clearing the throat, or frequently coughing without realising. It can also be a response to the irritants mentioned above. Coughing and throat clearing bangs the vocal cords together and makes the voice problem worse.

Your therapist will tell you if she has noticed you doing this. If so, increase your awareness of your throat clearing or coughing by asking family/friends to tell you each time they notice you doing this.

When you feel the need to clear your throat or cough, you could try having a sip of water or sucking a sugar free sweet.

Most of this advice is common sense but if you can identify and cut out irritants that you are exposed to, you will be helping yourself to improve the health and function of your vocal cords.