Laryngitis

Laryngitis

Breaking the Silence

There are 20 people gathered around the conference table. Each is looking at you expectantly. Each is waiting for the words of wisdom that will bring new insight to their work and maybe their lives.

You're humbled by all this attention. You stand, arrange the papers in front of you, clear your throat and open your mouth to speak.

And . . . nothing comes out. Nothing except a hoarse whisper that can't be heard past the woman sitting directly to your left.

This is not a nightmare--at least not the kind you have when you're asleep. It's the kind you get when you have laryngitis, that peculiar hoarseness and altered pitch that can make you sound like a cross between Lauren Bacall and Flipper. Sometimes your words come out in a low, breathy contralto, sometimes they come out with a high-pitched squeak. Sometimes they simply don't come out.

In any case, hormonal changes, bulimia, viruses, allergies, smoke-filled rooms and alcohol are frequent causes of laryngitis in women, says Michael Benninger, M.D., chief of otolaryngology at Henry Ford Hospital in Detroit. They trigger the inflammation, irritation or swelling in and around the vocal cords that physically alter the normal voice.

What's more, overuse, misuse or frank abuse can also cause laryngitis, says Dr. Benninger. Lecturing for a couple of hours when you're not used to it, carrying on a loud conversation on the subway or screaming for the home team at your annual alumni football game are all likely to send you into a day or so of silence.

The Hormone Connection

Most women experience some changes in their vocal cords a day or two before menstruation. In most cases the changes will be minor--a slightly lower pitch or a momentary hoarseness that generally goes unnoticed--but in others the change will be so significant that they may have difficulty carrying on prolonged conversations. They may even develop mild laryngitis.

"Just as there are certain women who have terrible premenstrual syndromes and others who have mild syndromes, we expect that same variation to occur," says Dr. Benninger. Other common premenstrual symptoms like bloating, cramping and headaches can also contribute to vocal changes.

How do hormones actually affect the vocal cords? Changing levels of estrogen and progesterone can cause body tissues to swell with fluid, says Dr. Benninger. The cords become heavier than normal, and your voice can sound low and hoarse. The hormonal changes at menopause have a similar effect.

For most of us these changes are not a problem. But for any woman for whom the nuances of voice are an important part of how she makes a living, here are Dr. Benninger's suggestions for dealing with premenstrual voice changes.

Understand that it's natural. "Number one is be aware that it's a normal process," he says. "It can be a normal component of the natural menstrual cycle. Don't worry about it--you don't have cancer and you're not going to have a permanent change in your voice--particularly not if the laryngitis happens at the same time every month and then goes away."

See a speech pathologist. "If voice changes or laryngitis affect your livelihood, voice therapy may be helpful," says Dr. Benninger. "Voice therapy is actually teaching you to use your voice in a way that helps you overcome the deficiencies that are occurring." A speech/language pathologist may help you offset some of the vocal problems caused by hormonal changes by teaching you certain posture or breathing techniques.

Change your repertoire. "If you're a speaker, you may want to do less--schedule fewer appointments around that time and do more paperwork instead," says Dr. Benninger. If you're a singer, you may not want to try to reach high "C"--you may want to change your repertoire a little so that you only reach high "A."

At the turn of the century, there were a substantial number of European opera houses that excused women from singing just before their periods. It was part of their contract. And there's some speculation that some of the most famous opera singers of all time--Maria Callas and Joan Sutherland--had premenstrual changes in their voices and therefore chose not to perform just before their periods.

Consider hormone therapy. "In women who have really severe problems, hormone therapy may be necessary," says Dr. Benninger. If laryngitis is really sabotaging your life and your career every month, discuss the idea of taking hormones with your gynecologist.

When the Problem Isn't Hormonal

If you are prone to laryngitis as a result of overusing your vocal cords, here's what you can do to prevent it.

Stay away from smoke. "Smoking has a direct effect on the vocal cords," says Dr. Benninger. Don't smoke yourself and don't hang out in places where others will blow smoke in your face.

Stay away from alcohol. "Alcohol has an indirect effect on the vocal cords," says Dr. Benninger. "It's a diuretic, so it dries the mucous membrane." In addition, alcohol loosens people up, often leading them to talk more loudly and for a longer period of time. The vocal cords then become irritated, with voice changes and laryngitis a natural result.

moisten your throat. Rev up the humidifier when you turn on the heat every winter, says Dr. Benninger. That can make a big difference in whether you get laryngitis.

Keep your mouth shut. Avoid talking, yelling or even whispering when you have laryngitis, says Dr. Benninger. It will only irritate your throat further.