What happens to the vocal folds
The voice is born where the exhaled air passes between two elastic folds of mucous membrane stretched across the larynx. The folds close and begin to vibrate hundreds of times per second, and the shape of the pharynx, mouth and nose transforms these vibrations into a recognizable timbre. For a clear sound, two things are needed: the folds must close completely and must be covered with a thin layer of moisture that allows them to slide.
With inflammation, both are disrupted. The mucous membrane swells, the folds thicken and become heavier, so they vibrate more slowly - the voice sounds lower and rougher. The swollen edges do not close tightly, leaving a gap between them through which air noisily escapes - hence the aspiration and hoarseness. When inflamed, mucus becomes thick and viscous, slippage worsens, and the person constantly coughs to clear the folds. Each such coughing is a sharp blow of the folds against each other, which increases the swelling. This creates a vicious circle: the more a person clears his throat, the more his voice deepens.
- Hoarseness and decreased pitch of voice are the first and most important signs
- Complete loss of voice, aphonia, with severe edema
- Dryness, scratching and burning in the Adam's apple, foreign body sensation
- Dry barking or rough cough, need to constantly clear throat
- Rapid voice fatigue: the first phrases sound normal, after a few minutes of conversation the voice disappears
- Pain when swallowing is mild - if it is severe, it is more likely to be pharyngitis or tonsillitis
Voice rest: why whispering is a bad idea
The advice to “keep quiet and whisper” sounds logical, but it contradicts the mechanics of the larynx. When whispering, the vocal folds do not relax: the front two-thirds close with force, while the back remains open to allow air to pass through. At the same time, the muscles of the larynx are tenser than during quiet normal speech, and a powerful flow of air through a narrow gap additionally dries out the mucous membrane. It turns out the opposite of what was intended: a person sincerely protects his voice and at the same time slows down his own recovery.
Proper vocal rest looks different. This is not complete silence at any cost, and certainly not a whisper, but a reduction in the number of words and speaking in an ordinary quiet voice at a comfortable height, without tension and without trying to shout above the noise. It is useful to agree in advance with your family and colleagues that for several days you will write messages instead of talking - this works better than any medicine.
- Говорите как можно меньше, но обычным спокойным голосом; шёпот исключите полностью.
- Не разговаривайте в шумных местах, в транспорте, при работающей вытяжке или музыке — там человек невольно повышает голос.
- Откажитесь от телефонных разговоров на несколько дней: по телефону люди говорят громче и напряжённее, чем вживую.
- Не откашливайтесь и не прочищайте горло — вместо этого пейте воду мелкими глотками.
- Пейте достаточно жидкости в течение всего дня: увлажнение складок изнутри важнее любых полосканий, потому что раствор при полоскании до складок физически не доходит.
- Увлажняйте воздух в комнате до 40-60 процентов, особенно в отопительный сезон и при работающем кондиционере.
- Полностью исключите курение, включая электронные устройства и кальян, а также пребывание в накуренном помещении.
Croup in children: the main cause of night panic
In children under six years of age, the larynx is narrow, and the mucous membrane under the vocal folds is loose and abundantly supplied with blood vessels. Swelling just one millimeter thick reduces the lumen of the airways in a baby by about half, while in an adult it is almost not felt. That is why a common viral infection in a child can cause laryngeal stenosis - a condition called false croup or acute stenotic laryngotracheitis.
The classic scenario is recognizable: during the day the child simply looked like he had a cold, with a slight runny nose and fever, and at night, usually between midnight and four o’clock in the morning, he suddenly woke up with a rough barking cough, a hoarse voice and noisy breathing. The parents get scared, the child gets even more scared from their reaction, and the fear intensifies the spasm - and the condition worsens before our eyes. Therefore, the first rule for croup concerns not the child, but the adult: remain calm and speak in an even voice.
- A barking, rough, ringing cough is the most characteristic sign; it is compared to the barking of a dog or the cry of a seal
- Hoarseness of voice until it disappears
- A noisy, whistling breath that can be heard from a distance is stridor; this is a key sign of narrowing of the larynx
- Worsening at night and in a horizontal position, child restlessness
- Alarming signs of increasing stenosis: retraction of the intercostal spaces and fossa above the sternum, participation in breathing of the wings of the nose, pallor, blueness around the mouth
- The child sits, refuses to lie down, breathes quickly and shallowly
- Вызвать скорую помощь, если есть шумный вдох в покое, втяжения на грудной клетке, синева или выраженная вялость.
- Успокоить ребёнка и взять на руки: плач и крик усиливают спазм и потребность в кислороде.
- Обеспечить приток прохладного влажного воздуха — открыть окно, вынести ребёнка на балкон или к открытой двери, укутав его.
- Придать вертикальное или полусидячее положение, расстегнуть тесную одежду.
- Дать тёплое питьё мелкими глотками, если ребёнок способен глотать.
- Не пытаться вызвать рвоту, не давать препараты, подавляющие кашель, и не проводить ингаляции горячим паром — риск ожога и ухудшения.
- Медикаментозная помощь при крупе — это ингаляционные и системные гормональные препараты, которые назначает врач; они снимают отёк за десятки минут и являются основой лечения.
When hoarseness ceases to be harmless
Acute laryngitis resolves in 5-10 days. If the voice has not recovered after two weeks, and even more so if hoarseness persists for longer than three weeks, we are no longer talking about a virus, and in this situation it is necessary not to continue treatment at random, but to look at the vocal folds themselves. The examination takes a few minutes: the doctor inserts a thin endoscope through the nose or uses a laryngeal mirror and sees the folds directly, assessing their mobility, color and presence of formations.
- Vocal fold nodules are typical for those who speak a lot and loudly: teachers, salespeople, singers, operators; the voice goes down by the end of the day and recovers overnight
- Polyps and cysts of the folds - cause persistent hoarseness, often after a single strong vocal overload or scream
- Chronic smoker's laryngitis is a persistent, rough hoarseness that requires mandatory examination, since it is a background for more serious changes.
- Reflux laryngitis - reflux of stomach contents into the larynx; morning hoarseness, lump sensation, coughing, unrelated to a cold are typical
- Vocal fold paralysis - often after operations on the thyroid gland, chest organs, less often for other reasons; the voice becomes breathy, the person chokes on liquid
- Tumors of the larynx - that’s why the three-week mark is important: the early stages are manifested only by hoarseness, and it is at this stage that the treatment results are best
A separate risk group is smoking men over 45 years of age and people who combine smoking with regular alcohol consumption. In them, prolonged hoarseness should be perceived as a reason for examination in the coming days, and not in a month. Additionally, ear pain on the same side without ear disease, difficulty swallowing, an enlarged painless node in the neck, blood in the sputum and weight loss are also alarming. None of these signs is diagnostic by itself, but each requires direct examination of the larynx.
Chronic laryngitis and vocal hygiene
Chronic laryngitis develops when irritation of the larynx becomes constant. This is not the result of an untreated cold, but a consequence of lifestyle, profession or concomitant illness. Accordingly, treatment is aimed at eliminating the cause, and not at suppressing the symptom.
- Smoking is a major factor; giving it up gives improvement within a few weeks, although complete restoration of the mucous membrane takes months
- Professional voice workload without technology: shouting, talking against a background of noise, speaking at an awkward height
- Gastroesophageal reflux: acidic contents reach the larynx, often at night; Eating dinner no later than three hours before bedtime, raising the head of the bed, and treatment with a gastroenterologist help
- Constant breathing through the mouth with a stuffy nose - air enters the larynx unmoistened and uncleaned
- Dry air, dust, chemical fumes in production
- Inhaled hormonal drugs for asthma without subsequent mouth rinsing are a local cause of hoarseness, which can be solved by the technique of application.
People for whom the voice is a working instrument benefit from sessions with a phoniatrist and a voice specialist. This is not about vocal exercises, but about staging speech breathing, finding a comfortable pitch of the voice and the ability to speak loudly without straining the larynx. This is a skill that can be mastered in a few lessons and eliminates most of the problems for teachers and those who talk on the phone a lot. Additionally, it makes sense to schedule voice breaks throughout the day: 10 minutes of silence after every hour of intense conversation reduces the load on the folds noticeably more than any lozenges.
