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Originally published Sunday, April 24, 2005 at 12:00 AM

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Losing your voice can be sign of something serious

Chuck McDowell gave speeches. He sang with a band. But everything changed when his voice disappeared, leaving McDowell feeling frightened...

Newhouse News Service

Chuck McDowell gave speeches. He sang with a band. But everything changed when his voice disappeared, leaving McDowell feeling frightened and isolated.

"I was having to speak into an amplifier just to have a conversation at home," said the 46-year-old financial adviser from Duluth, Ga. "If I was in a restaurant, I could not be heard unless I put my amplifier on the table and turned it up."

Eventually, McDowell had a growth removed from his vocal cords, a procedure he now jokingly recalls as easier than some haircuts. But in the 18 months it took to summon the courage for surgery, he experienced the unsettling questions familiar to nearly everyone at least once in a lifetime: Where did my voice go? How do I get it back?

Experts believe that at any given time, more than 7 million Americans suffer from voice disorders, and that number is likely to grow. Longer lives may result in more voices muted by age-related fatigue. Meanwhile, the modern era — with so many service-sector jobs such as sales, and so much yapping on cellphones — is a recipe for voice strain.

"Some people have a hypothesis, that the cellphone is the vocal endurance test for the new millennium," said voice-disorder specialist Dr. Michael Johns, director of the Emory Voice Center of Emory University in Atlanta.

The key to effective voice production is healthy vocal cords, which experts call vocal folds. They lie horizontally in the throat just behind the Adam's apple — a side-by-side pair in the larynx, or voice box, atop the windpipe.

Common voice disorders


Acute laryngitis, caused by a viral infection and vocal-cord swelling, is the most common cause of sudden hoarseness or voice loss. Staying hydrated and talking less are the best treatments. Serious injury can result from strenuous voice use during laryngitis.

Chronic laryngitis can be caused by acid-reflux disease, exposure to smoke or other irritants, or by low-grade infections among people using inhalers for asthma.

Laryngopharyngeal reflux disease, which causes the reflux of stomach fluids into the throat, can cause hoarseness and other problems.

Overuse of the vocal cords, like overuse of any muscle, can lead to vocal fatigue, hoarseness and increased vocal effort. Studies have shown teachers are most susceptible. Experts recommend limiting conversation in noisy situations, using a microphone when public speaking, moderating cellphone use, drinking plenty of water and limiting dehydrating drinks such as caffeine and alcohol.

Vocal cord lesions, such as non-cancerous polyps, cysts or nodules, can occur from overuse or misuse. They cause hoarseness. All are treatable.

Laryngeal cancer, sometimes preceded by chronic hoarseness, afflicts about 10,000 Americans annually and killed 3,770 in 2005. If treatment is prompt, it can be cured.

American Academy of Otolaryngology — Head and Neck Surgery

During speech, air is pushed upward from the lungs and through the windpipe. The air streams between the vocal cords, which spread apart and close together like a pair of sliding doors over a porthole. Sound is made when the vocal cords vibrate — about 110 times per second in men, and nearly twice that rate in women. That sound is turned into words by the workings of the mouth, nose and throat.

The vocal cords, which are about half an inch long, are made up of muscle and layers of mucosa. Many things can damage this tiny layer cake of soft tissue, and that's when voice disorders can occur.

"If someone wakes up one morning and stays hoarse for a couple of weeks, they need to get evaluated," said Katherine Verdolini, an associate professor of communication science and disorders at the University of Pittsburgh. "These are ... symptoms that can be linked to hundreds of different pathologies."

Susan Thibeault, a University of Utah assistant professor who researches how tissue engineering might help repair surgical scars on vocal cords, said estimates that 3 percent to 9 percent of the population has voice disorders is probably low.

"There are tons of people who have neurological voice problems who just live with them because they don't know what to do," Thibeault said. "I recently talked to a doctor who said someone came in with a problem (he'd had) for 15 years."

Most disorders are treatable. In McDowell's case, surgery was the best way to remove his polyp.

In other cases, voice exercises provide the necessary rehabilitation. Verdolini said many older people benefit from such workouts.

"A large number of problems of the aging voice are due to atrophy," she said. "It's clear that exercises can be done to strengthen the muscles."

Betty Knuckey, 55, initially blamed voice overuse for chronic hoarseness she experienced in 2003. Her self-diagnosis seemed sensible; for about a week, Knuckey had carried a heavy workload at a computer-software company because three co-workers were not on the job.

"I was on the help desk," said Knuckey, of Cumming, Ga. "I took 30 to 50 calls a day. That's a lot of talking. It got where I couldn't talk. (My voice) would crack. I had to use everything I had just to talk."

Doctors initially blamed strained vocal cords, or a sinus infection. But talking less or taking antibiotics offered no relief. Eventually, a throat examination with a miniature camera showed a growth on her right vocal cord.

Johns, Knuckey's doctor, removed the malignant tumor in November 2003.

Knuckey doesn't enjoy the ongoing checks to make sure the cancer is gone. But they're better than the alternative. Knuckey has known three people who died of throat cancer. One, her ex-husband, didn't see a specialist for three or four months. The delay may have cost him his life.

"If I had waited another month, it would have been a lot worse," Knuckey said.

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