The sound of your voice is produced by vibration of the vocal folds, which are two bands of smooth muscle tissue that are positioned opposite each other in the larynx. The larynx is located between the base of the tongue and the top of the trachea, which is the passageway to the lungs (see figure).

When you are not speaking, the vocal folds are open so that you can breathe. When it's time to speak, however, the brain orchestrates a series of events. The vocal folds snap together while air from the lungs blows past, making them vibrate. The vibrations produce sound waves that travel through the throat, nose, and mouth, which act as resonating cavities to modulate the sound. The quality of your voice—its pitch, volume, and tone—is determined by the size and shape of the vocal folds and the resonating cavities. This is why people's voices sound so different.

Many people use their voices for their work. Singers, teachers, doctors, lawyers, nurses, sales people, and public speakers are among those who make great demands on their voices. This puts them at risk for developing voice problems. An estimated 17.9 million adults in the U.S. report problems with their voice. Some of these disorders can be avoided by taking care of your voice.

Voice is the sound made by air passing from your lungs through your larynx, or voice box. In your larynx are your vocal cords, two bands of muscle that vibrate to make sound. For most of us, our voices play a big part in who we are, what we do, and how we communicate. Like fingerprints, each person's voice is unique.

Many things we do can injure our vocal cords. Talking too much, screaming, constantly clearing your throat, or smoking can make you hoarse. They can also lead to problems such as nodules, polyps, and sores on the vocal cords. Other causes of voice disorders include infections, upward movement of stomach acids into the throat, growths due to a virus, cancer, and diseases that paralyze the vocal cords.

Signs that your voice isn't healthy include

• Your voice has become hoarse or raspy
• You've lost the ability to hit some high notes when singing
• Your voice suddenly sounds deeper
• Your throat often feels raw, achy, or strained
• It's become an effort to talk

Treatment for voice disorders varies depending on the cause. Most voice problems can be successfully treated when diagnosed early.

Causes of voice problems include:

• Upper respiratory infections
• Inflammation caused by gastroesophageal reflux (sometimes called acid reflux, heartburn, or GERD)
• Vocal misuse and overuse
• Growths on the vocal folds, such as vocal nodules or laryngeal papillomatosis
• Cancer of the larynx
• Neurological diseases (such as spasmodic dysphonia or vocal fold paralysis)
• Psychological trauma.

Most voice problems can be reversed by treating the underlying cause or through a range of behavioral and surgical treatments.

If you answer "yes" to any of the following questions, you may have a voice problem:

• Has your voice become hoarse or raspy?
• Have you lost your ability to hit some high notes when singing?
• Does your voice suddenly sound deeper?
• Does your throat often feel raw, achy, or strained?
• Has it become an effort to talk?
• Do you find yourself repeatedly clearing your throat?

If you think you have a voice problem, consult a doctor to determine the underlying cause. A doctor who specializes in diseases or disorders of the ears, nose, and throat, and who can best diagnose a voice disorder, is an otolaryngologist (oh-toe-lar-in-GAH-luh-jist), sometimes called an ENT. Your otolaryngologist may refer you to a speech-language pathologist. A speech-language pathologist can help you improve the way you use your voice.

The National Institute on Deafness and Other Communication Disorders (NIDCD) supports research that includes laboratory studies to understand diseases and stresses that can harm the voice, and clinical research to test new ways to diagnose, treat, or cure voice disorders.

Researchers are exploring how the brain controls the muscles and nerves of the larynx and tongue, and how these structures move to produce speech. This information may help other scientists design better treatments for conditions such as vocal fold paralysis and spasmodic dysphonia, which can damage the voice. It may also help researchers design new rehabilitation strategies to improve the quality of life for people challenged by severe voice disorders.

Another area of interest to researchers is developing replacement tissues to repair damaged vocal folds. NIDCD-funded scientists are testing man-made and biological materials and stem cell technologies that may eventually be used to engineer new vocal fold tissues, as well as methods to encourage nerve regrowth to treat laryngeal paralysis.

Researchers are also looking at new ways to assess vocal disorders and testing new methods of voice therapy for people with growths on the vocal folds. Research continues to explore ways to prevent scarring of the vocal fold after injury and to treat vocal scarring when it occurs. Additional ongoing research studies aim to understand the mechanisms of laryngeal papillomatosis caused by HPV (human papillomavirus), and to develop new drug treatments for the disorder.

New techniques to combat age-related weakness in the laryngeal muscles have the potential to prevent voice disorders in the aging population. Recent results from NIDCD-funded researchers showed that, in an animal model of the aging voice, vocal training exercises helped the muscles of the larynx stay strong.

Because teachers have a high incidence of vocal disorders, the NIDCD is supporting the development of an educational website for teachers to support healthy behaviors and protection of their voices. The NIDCD is also supporting research into the effectiveness of voice hygiene education and voice production training for teachers.

In many ways, your voice is as unique as your fingerprint. It’s produced in your throat by 2 bands of muscle tissue called vocal folds, which sit at the top of your windpipe. The larynx, commonly called the voice box, houses the vocal folds.

When you speak, the folds come together as air from your lungs rushes through them. The air blowing through the folds makes them vibrate. The vibrations make sound waves that travel through your throat, nose, and mouth. The size and shape of these structures create the pitch, loudness, and tone of your voice. That’s why each person’s voice sounds so different.

“Your voice adds a layer of meaning to your words,” says Dr. Lana Shekim, a voice and speech expert at NIH. Whether you’re joyful, disappointed, or grieving, your voice helps to convey your emotions to others, with or without words. Even before infants can speak, they make happy or distressed vocalization to communicate with caregivers.

People who depend on their voices for work—like teachers, lawyers, singers, and politicians—are at risk of overusing their voice. Overuse and misuse of your voice such as screaming, cheering, or talking above loud background noises can strain your vocal folds. It’s best to avoid such activities. Perhaps you’ve woken up with a hoarse voice after attending a concert or a sporting event. Repeatedly clearing your throat; a raw, achy throat; a deeper voice; or a sudden inability to hit high notes when singing are also signs of an unhealthy voice.

“We often protect a musical instrument, like a violin, by carefully storing it inside a wooden box lined with soft velvet,” says Shekim. “But we don’t think about protecting our own voices in the same way. The truth is: we can buy a new violin, but we cannot buy a new larynx.”

It’s important to identify and avoid behaviors that might harm your voice. For example, instead of speaking loudly when talking to a large group, consider arranging for a microphone. On days that your voice sounds raspy or hoarse, protect it by not straining or overusing it. Choose a quiet restaurant when meeting friends for a meal.

“In keeping your voice healthy, always remember, what is good for your well-being is good for your voice,” Shekim adds. Drinking plenty of water and using your voice less should help relieve hoarseness from misuse or overuse.

Although many voice conditions result from misuse or overuse, other voice disorders may be related to disease. Voice disorders may result from growths on the vocal folds, gastric reflux, head or neck cancer, neurological problems, or other causes.

If you think you have a voice problem, talk with your health care provider. They may recommend that you see a specialist—such as an ear, nose, and throat doctor (otolaryngologist) or a speech-language pathologist—to help diagnose and treat voice issues.

Avoid Voice Problems

• Drink 6 to 8 glasses of water a day. This helps keep your vocal folds moist and healthy.
• Limit intake of caffeinated or alcoholic drinks. These can dehydrate your body and make the vocal folds and larynx dry.
• Don’t smoke, and avoid second-hand smoke. Cigarette smoke can irritate the vocal folds.

Stay hydrated:

• Drink plenty of water, especially when exercising.
• If you drink caffeinated beverages or alcohol, balance your intake with plenty of water.
• Take vocal naps—rest your voice throughout the day.
• Use a humidifier in your home. This is especially important in winter or in dry climates. Thirty percent humidity is recommended.
• Avoid or limit use of medications that may dry out the vocal folds, including some common cold and allergy medications. If you have voice problems, ask your doctor which medications would be safest for you to use.

Maintain a healthy lifestyle and diet:

• Don't smoke, and avoid second-hand smoke. Smoke irritates the vocal folds. Also, cancer of the vocal folds is seen most often in individuals who smoke.
• Avoid eating spicy foods. Spicy foods can cause stomach acid to move into the throat or esophagus, causing heartburn or GERD.
• Include plenty of whole grains, fruits, and vegetables in your diet. These foods contain vitamins A, E, and C. They also help keep the mucus membranes that line the throat healthy.
• Wash your hands often to prevent getting a cold or the flu.
• Get enough rest. Physical fatigue has a negative effect on voice.
• Exercise regularly. Exercise increases stamina and muscle tone. This helps provide good posture and breathing, which are necessary for proper speaking.
• If you have persistent heartburn or GERD, talk to your doctor about diet changes or medications that can help reduce flare-ups.
• Avoid mouthwash or gargles that contain alcohol or irritating chemicals.
• Avoid using mouthwash to treat persistent bad breath. Halitosis (bad breath) may be the result of a problem that mouthwash can't cure, such as low grade infections in the nose, sinuses, tonsils, gums, or lungs, as well as from gastric acid reflux from the stomach.

Use your voice wisely:

• Try not to overuse your voice. Avoid speaking or singing when your voice is hoarse or tired.
• Rest your voice when you are sick. Illness puts extra stress on your voice.
• Avoid using the extremes of your vocal range, such as screaming or whispering. Talking too loudly and too softly can both stress your voice.
• Practice good breathing techniques when singing or talking. Support your voice with deep breaths from the chest, and don't rely on your throat alone. Singers and speakers are often taught exercises that improve this kind of breath control. Talking from the throat, without supporting breath, puts a great strain on the voice.
• Avoid cradling the phone when talking. Cradling the phone between the head and shoulder for extended periods of time can cause muscle tension in the neck.
• Consider using a microphone when appropriate. In relatively static environments such as exhibit areas, classrooms, or exercise rooms, a lightweight microphone and an amplifier-speaker system can be of great help.
• Avoid talking in noisy places. Trying to talk above noise causes strain on the voice.
• Consider voice therapy. A speech-language pathologist who is experienced in treating voice problems can teach you how to use your voice in a healthy way.

Speaking, singing, and making other sounds require many parts of your body to work together. Your brain thinks of ideas. Your lungs move air in and out. Your vocal cords vibrate. Your mouth and nose help shape sound.

“Our whole body participates in the production of voice, speech, and breathing. So we can get a lot of information about our health from them,” says Dr. Yael Bensoussan, a voice researcher at the University of South Florida.

Many conditions can impact the various body parts involved in sound production. These include depression, Parkinson’s disease, Loss of thinking, memory, and reasoning skills that seriously affects your ability to carry out daily activities. dementia, lung problems, and even cancer. Measuring voice, speech, and breathing patterns could help diagnose health problems.

Researchers are testing ways to use apps and other tools to let people measure such information at home. For example, a recent study showed that a computer program could identify patients with Parkinson’s disease by their breathing patterns during sleep.

“Voice, speech, and breathing are easy to access, inexpensive, and non-invasive to measure,” Bensoussan says. “For example, for a test for lung function, you currently have to go to a hospital and blow into a machine. Then you need someone to analyze that test. Just recording your voice or breathing sounds on your phone would be a lot cheaper and easier.”

Speech pattern analysis has shown promise for diagnosing impairments in memory or thinking abilities, and mental health conditions like depression. The way people speak, the tone of voice, and even the words used can all change when someone develops depression, explains Dr. Gari Clifford, a biomedical engineer at Emory University and Georgia Institute of Technology.

Clifford’s team is trying to use speech patterns and facial expression changes to catch depression early in people with dementia. They are now testing their technology in certain tablet and smartphone apps to track changes in people’s daily health. This could help doctors see the effects of depression treatments in real time and change them quickly if needed. It could also provide early warning that someone’s health is declining.

Other NIH-funded research teams are testing speech analysis to screen for additional mental health problems, like anxiety. They’re also looking at speech patterns to help diagnose diseases like amyotrophic lateral sclerosis (ALS) early.

Bensoussan’s team is building the world’s largest collection of voice and speech samples related to health information. They’re including people from a wide range of backgrounds and health conditions. They hope this will aid researchers in building new tools for diagnosis.

Voice and speech analysis tools will eventually have to take people’s whole health into account, just like a doctor would, Bensoussan says. “Multiple different diseases can cause the same voice changes. For example, for a hoarse voice, someone with cancer of the throat and someone with laryngitis can sound exactly the same,” she explains.

You can’t yet talk into your phone and get a full health report. But Bensoussan encourages people to pay attention to changes in their voice and speech. “If you have a voice change for more than two to three weeks, it may indicate an issue with your health,” she says. See the Wise Choices box for signs to look for.

Pay Attention to Your Voice

Talk with your doctor if you notice changes in your voice, speech, or breath lasting over a few weeks:

• Hoarseness or a raspy quality to your voice.
• Changes in the pitch of your voice (how low or high it is).
• Your throat feeling raw, achy or strained.
• Difficulty talking.
• Repeatedly feeling the need to clear your throat.
• A cough that doesn’t go away.
• Problems thinking of the words you want to use or putting words in the right order.