There is a rather strange moment that happens as we get older.
You hear yourself speaking on a recording and think:
“Is that really my voice?”
It may sound deeper. A little weaker. More croaky. Perhaps slightly breathy or strained.
Sometimes family members notice it before we do.
And although we often blame it on getting older, there can be several reasons why our voice changes.
As a pharmacist, I have had people mention this to me in pharmacy, usually when they are talking about something completely different.
“I don’t know what’s happened to my voice lately.”
So why does it happen?
Your voice is a surprisingly complicated thing
Your voice is produced in the larynx — commonly called the voice box.
Inside it are two small folds of tissue called the vocal cords. When you speak, air from your lungs passes through them and makes them vibrate. Your throat, mouth and nose then help shape that sound.
As we age, the tissues and muscles involved in producing our voice can change. This can contribute to a voice becoming quieter, weaker or breathier.
But ageing isn’t the only explanation.
Sometimes it is simply irritation
One of the common causes of a temporary change in voice is laryngitis.
Laryngitis happens when the voice box or vocal cords become irritated or swollen. It is often linked to viral infections such as colds and flu, and usually settles by itself within one to two weeks. NHS — Laryngitis
You may suddenly become hoarse or even lose your voice altogether.
The good news is that most straightforward cases get better without specific treatment.
Resting your voice and drinking plenty of fluids can help. The NHS also advises avoiding smoking, excessive caffeine and alcohol while you have laryngitis. NHS — Laryngitis
And here is something many people don’t realise:
Don’t whisper.
Whispering can put strain on the voice just as speaking loudly can. NHS — Laryngitis
The throat-clearing trap
Here is something I see quite often.
Someone develops a slight irritation in the throat.
They clear their throat.
That irritates it a little more.
So they clear it again.
And again.
Before long, they have developed a habit of repeatedly clearing their throat throughout the day.
Repeated throat clearing can cause the vocal cords to come together forcefully and may contribute to irritation and voice changes. Hull University Teaching Hospitals NHS Trust — Voice care
Sometimes taking a sip of water or swallowing instead can be kinder to the throat.
Could reflux be affecting your voice?
This is another possibility that is easily overlooked.
Most people associate acid reflux with heartburn.
But reflux can also cause a hoarse voice, cough and repeated throat clearing. NHS — Heartburn and acid reflux
Acid and stomach contents can irritate the throat and voice box, sometimes causing a change in voice quality. Cambridge University Hospitals NHS — Acid reflux and your voice
And you don’t necessarily have to experience obvious heartburn.
Some people mainly notice throat symptoms.
If reflux appears to be contributing, avoiding large meals late in the evening and not lying down soon after eating may help. Caffeine and alcohol can also aggravate reflux in some people. Cambridge University Hospitals NHS — Acid reflux and your voice
If the problem keeps returning, speak to your pharmacist or GP rather than simply treating yourself indefinitely.
Don’t forget your medicines
As a pharmacist, this is one area I would always consider.
Some medicines can cause a dry mouth or throat, which can make speaking uncomfortable.
Inhaled corticosteroids can also cause problems in the mouth and throat if they are not used correctly.
If you use a steroid inhaler, make sure your technique is correct and follow the advice supplied with your inhaler.
And if you think a medicine may be affecting your voice, don’t simply stop taking it.
Ask your pharmacist or doctor.
There may be a simple solution.
What about dehydration?
Your voice works better when the tissues involved are adequately hydrated.
Drinking plenty of fluids is recommended when you have laryngitis, while excessive caffeine and alcohol can contribute to dehydration. NHS — Laryngitis
This can be particularly relevant after a long day of talking, travelling, exercising or simply forgetting to drink enough.
Sometimes the simplest advice is also the most useful:
Drink some water.
When should you get your voice checked?
This is the part I particularly want people to remember.
Most episodes of hoarseness are caused by relatively straightforward problems.
But a persistent, unexplained change in your voice should not simply be dismissed as “getting older”.
NICE recommends an urgent suspected-cancer referral for people aged 45 and over with persistent, unexplained hoarseness. NICE — Suspected cancer: recognition and referral
That does not mean persistent hoarseness is cancer.
It means that persistent unexplained hoarseness deserves proper assessment rather than simply being ignored.
You should also seek medical advice if your voice problem keeps returning, particularly if it is accompanied by symptoms such as difficulty swallowing, a lump in the neck, unexplained weight loss or breathing difficulties.
And if you are having significant difficulty breathing, seek emergency medical help. NHS — Laryngitis
What can you do to protect your voice?
There are some wonderfully unglamorous but sensible measures.
Drink regularly.
Don’t smoke.
Avoid shouting when possible.
Try not to repeatedly clear your throat.
Give your voice a break if you have been talking for long periods.
If you suffer from reflux, deal with it rather than continually ignoring the symptoms.
And don’t assume that every hoarse voice needs an antibiotic. Laryngitis is often caused by viruses, and most cases settle without specific treatment. NHS — Laryngitis
The pharmacist’s takeaway
Our voice is something most of us take completely for granted.
Until it changes.
A temporary croaky voice after a cold, a lot of talking or throat irritation is usually nothing particularly worrying.
But there is an important difference between a voice that changes occasionally and one that remains persistently different for no obvious reason.
If your voice has remained hoarse for weeks rather than days, don’t simply accept it as another sign of getting older.
Get it checked.
It may turn out to be something very straightforward.
But sometimes the sensible thing to do is simply to listen to what your body — and in this case, your voice — is telling you.
Until next time, look after your voice. You may not realise how much you rely on it until it starts to sound different.
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