Why Your Voice Matters: What an ENT Voice Specialist Wants You to Know

We use our voices constantly.

Talking to colleagues. Calling family. Teaching. Presenting. Singing. Shouting across a football pitch. Yet most of us give remarkably little thought to how our voice actually works — until suddenly it doesn’t.

In this episode of The Dokkcast, Dr Nara Daubeney speaks with Declan Costello, consultant ear, nose and throat surgeon and specialist in voice disorders, about the extraordinary mechanics of the human voice, what happens when things go wrong and when a change in your voice deserves medical attention.

Declan brings an unusual perspective to the subject. Before studying medicine, he studied music at St John’s College, Cambridge, where he was a choral scholar. Today, his clinical work brings those two worlds together, treating everyone from professional singers, actors and broadcasters to people who simply want their normal speaking voice back.

Your voice is more complicated than you might think

Sound begins with two small structures in the larynx commonly called the vocal cords — although vocal folds is a more accurate description.

As air travels from the lungs, the vocal folds come together and vibrate, sometimes hundreds of times every second. That vibration produces the basic sound of the voice.

But that is only the beginning.

The throat and mouth then act as resonating spaces, modifying the sound and its harmonics to produce the huge variety of vowels, tones, pitches and qualities that make every human voice distinctive.

For professional singers, understanding and controlling these characteristics becomes an extraordinary physical skill.

Declan explains how classical singers, for example, can develop what is known as the singer’s formant — accentuating particular harmonic frequencies to create the bright, projecting quality that allows an unamplified human voice to carry over an orchestra.

But you don’t need to be an opera singer for the health of your voice to matter.

When something changes, the voice can tell us a lot

One of the most important messages from the conversation is remarkably straightforward:

Persistent hoarseness should be checked.

A hoarse voice can have many causes. Benign vocal cord polyps, irritation, papillomas and other conditions can all interfere with the smooth movement of the vocal folds.

Sometimes, however, persistent hoarseness can be a symptom of something more serious.

Declan recommends seeking medical advice if a voice problem remains persistent for around three to four weeks, particularly for people over 45 and those who smoke or have smoked.

The distinction between persistent and intermittent symptoms is important.

A voice that becomes tired or husky towards the end of the day but returns to normal may be different from a voice that becomes hoarse and simply never returns to normal.

The latter deserves investigation.

Why singers notice voice problems sooner

Professional singers often detect extremely subtle changes to their voices.

A singer might seek help because a particular note or register suddenly feels different — long before somebody who doesn't sing professionally would notice anything unusual.

Interestingly, Declan estimates that around two-thirds of the singers he examines do not have an identifiable physical problem on the surface of their vocal cords.

That can be reassuring.

Instead of surgery or prolonged rest, treatment may involve vocal coaching or working with a speech and language therapist to address how the voice is being used.

When physical abnormalities are present, however, even something tiny can have a noticeable effect.

The vocal folds need to meet cleanly and remain extremely supple. A small lump, swelling or area of stiffness can interfere with their vibration and produce a hoarse or husky voice.

Your emotions can affect your voice

The voice isn't simply mechanical.

It is intimately connected to our emotional state.

Most of us have experienced this ourselves. Anxiety before speaking in public can change the voice. Being upset can make speech sound different. Stress can create tension that changes how easily we produce sound.

In more extreme circumstances, Declan explains that people can experience aphonia — a complete loss of voice — without there necessarily being a structural problem with their vocal cords.

Treatment can involve specialist speech and language therapy, addressing both the mechanics of producing the voice and some of the psychological factors contributing to the problem.

There can also be a vicious circle.

Someone becomes worried about their voice. That worry produces muscular tension. The tension makes using the voice more difficult. The worsening voice then creates more anxiety.

For professional voice users in particular, getting an unexplained change investigated can therefore provide something extremely valuable: reassurance.

Speech therapy is physiotherapy for your voice

One of the most useful ways to think about speech and language therapy is as a form of physiotherapy for the voice.

The larynx and vocal tract involve muscles, ligaments and moving tissue. When those systems aren't working together efficiently, specialist exercises can help restore coordination and function.

Just like conventional physiotherapy, however, improvement doesn't only happen during an appointment.

Patients may be given exercises to practise regularly between sessions, gradually retraining the way they use their voice.

Different therapists may also specialise in different problems — from professional singers to voice loss, chronic cough or persistent throat clearing.

That constant throat clearing may be making things worse

Persistent throat clearing is another problem Declan sees regularly.

Someone feels irritation or mucus in their throat, so they clear it.

But clearing your throat brings the vocal folds forcefully together. That can create more irritation, which produces another urge to clear the throat.

The result can become a self-perpetuating cycle.

One simple strategy Declan discusses is to interrupt that behaviour: keep water nearby and, when you feel the urge to clear your throat, stop and swallow instead.

Over time, reducing the repeated irritation may allow the symptoms to settle.

Not every throat problem is 'silent reflux'

Reflux has become a common explanation for persistent throat and voice symptoms.

But Declan argues that the reality can be considerably more complicated.

Throat irritation, coughing, voice changes and the sensation of something being stuck in the throat can have multiple causes. He cautions against assuming that symptoms automatically mean reflux simply because the throat appears irritated.

That includes the condition known as globus pharyngeus — the very real sensation that there is a lump or constriction in the throat despite no physical lump being visible during examination.

After appropriate examination has ruled out concerning causes, treatment may focus on reducing irritation, breaking patterns such as throat clearing and addressing factors such as stress.

Does drinking water actually help your voice?

Yes — but perhaps not for the reason you imagine.

When you drink water, it doesn't wash directly over your vocal folds. It travels down the oesophagus towards the stomach.

Instead, hydration works systemically.

Being adequately hydrated helps keep saliva and mucus thinner and more watery, reducing the likelihood of thick secretions contributing to throat irritation.

Declan also discusses steam inhalation, something commonly used by singers, actors and broadcasters to help moisturise and soothe the throat.

Your voice changes as you get older

Like many other parts of the body, the voice changes with age.

One important change is a gradual reduction in muscle tone and strength within the vocal folds.

If they no longer close together as effectively, more air can escape during speech, potentially making the voice sound weaker or more breathy.

This can become particularly noticeable when someone suddenly stops using their voice as much.

Declan gives the example of a teacher who has spent decades talking for hours every day before retiring. Their daily vocal workload can suddenly fall dramatically at exactly the same time that age-related muscle changes are beginning to occur.

The solution isn't necessarily to rest the voice.

It may be the opposite.

Your voice really can be 'use it or lose it'

One of the most surprising misconceptions discussed in the episode is the idea that a troublesome voice should always be rested.

Sometimes voice rest is medically appropriate.

But prolonged, unnecessary rest can also mean the muscles involved in producing the voice receive even less exercise.

For somebody experiencing age-related weakness, Declan suggests actively using the voice — talking, reading aloud or singing. Specialist voice therapy can also provide structured exercises where appropriate.

Singing may have benefits beyond the voice too, offering social interaction, respiratory activity and the simple pleasure of doing something that demands your complete attention.

So when should you get your voice checked?

Declan describes several useful scenarios.

If your voice has persistently changed and hasn't returned to normal after around three or four weeks, particularly if you're over 45 or have a history of smoking, seek medical advice.

If your voice fluctuates — perhaps becoming tired later in the day before recovering — it may be reasonable to monitor it for longer, although persistent problems should still be discussed with a healthcare professional.

And if you've simply lost your voice after shouting your way through a night out, the cause may be rather more obvious.

The important thing is to notice what is normal for you.

Your voice is something you use every day. A lasting change deserves attention.

Listen to the full conversation

In the full episode, Dr Nara Daubeney and Declan Costello explore the science of voice in much greater depth — from vocal folds, harmonics and professional singing to polyps, cancer warning signs, speech therapy, hydration, reflux, globus and what happens to our voices as we age.

It is also a fascinating conversation with someone whose professional and personal worlds overlap in an unusual way: an ENT surgeon who understands the voice not only as a clinician, but as a lifelong singer.

Listen to The Dokkcast on Spotify, Apple Podcasts and YouTube.

The Dokkcast is from Udokk — bringing you better health conversations, led by people who know.