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What you eat or drink can cause acid reflux, which can damage your vocal cords. JONATHAN LIAUTRAKUL reports
The late Hong Kong superstar Leslie Cheung was known for his chart-topping songs, but few knew his vocal cords suffered constantly from acid reflux. This affected his singing career, as he was unable to project his voice to its best effect. That caused the singer distress but unless you use your pipes for a living, the odds are you would not give them much thought.
 Still, if World Voice Day squeaked past you unnoticed last Saturday, do not imagine that it cannot happen to you. Anyone can lose their voice and it may not be from overuse, but from food and drink. Ms Ch’ng Kim See found this out the hard way in 2009 when she developed a wicked tickle in the throat that made her cough a lot. “When I gave presentations or spoke at meetings, I would have to stop as my throat would start to itch,” said the 64-year-old librarian. Her throat felt swollen and her voice grated.
An allergic reaction to dust was suspected, but it was not until she was referred to Dr David Lau, a senior consultant at the department of otolaryngology at Singapore General Hospital (SGH), that she was diagnosed with an inflammation of the vocal cords from acid reflux.
Acid reflux occurs when stomach acid and digestive juices move up the oesophagus, and sometimes into the throat, because of a weakness in the valve mechanism at the lower end of the oesophagus. Acid reflux could cause more than just that familiar feeling of heartburn. The vocal cords could also be irritated as the tissues are not well protected against stomach acids.
The larynx, also known as the voice box, houses the vocal cords – folds of tissue that generate sound through their rhythmic opening and closing. What follows acid reflux could be hoarseness, or voice loss, swelling, ulceration or the formation of nodules or polyps, explained Dr Lau. Ms Ch’ng’s hoarseness improved with speech therapy, but there was one sacrifice the Peranakan had to make. “I had to give up spicy food. I am a Nonya, so I’m used to eating chillis. But I guess it’s better to avoid them now,” she said.
The culprits of acid reflux include spicy food like laksa, citrus fruits and “heaty” food like char kway teow, said Dr Lau. Such foods have a tendency to increase the level of acidity in the stomach or loosen the lower oesophageal valve, thus causing reflux. Overeating also increases the risk of acid reflux, said doctors.
“Eat in moderation” is the advice from Dr Duncan Wong, an ear nose and throat surgeon at Khoo Teck Puat Hospital. “If we eat a heavy meal, the stomach becomes distended and the lower oesophageal valve is stretched, allowing the acid to flow up.” The voice can also be damaged by other things, like whispering, which strains the larynx more than normal speech, said Dr Wong. Overuse, in occupations like teaching, singing and coaching, could also contribute to vocal damage. “There has been a 20 per cent increase in patients with voice loss in the last five years, of which a significant number are teachers, who usually project their voice over long hours,” said Ms Wong Seng Mun, a senior speech therapist at SGH.
Screaming or shouting can also aggravate the voice folds. Early signs of voice loss include hoarseness, a change in quality which may persist over time, an inability to maintain normal pitch and loudness of voice and soreness in the throat after talking. Medical conditions such as laryngitis, cold and flu may temporarily affect the vocal cords, while long-term effects such as vocal paralysis from nerve injury, cancers or other growths in the throat can also occur.
There are several treatments available, such as speech therapy, a change in diet and lifestyle, or microsurgery to remove polyps that are found in the throat. Take care of your vocal cords by keeping hydrated and having sufficient rest while looking out for acid reflux, voice changes and sore throats. Also, try to improve your vocal technique through proper voice projection, said Ms Wong.
Here’s how to protect your voice
Give your voice sufficient rest
This might be tough for people who have to use their voices throughout the day, like teachers. Try to have short breaks to rest your voice at intervals of 15 minutes during the teaching day and avoid using it continually during the weekend.
Keep hydrated
One should drink at least 2 1/2 litres of water a day to keep the vocal cords hydrated. Avoid caffeinated and carbonated drinks, as well as too much citrus juice and alcohol. Also, avoid smoky environments.
Avoid wearing tight clothing and control your weight
Tight clothing and being overweight increase the pressure within the abdomen. This pushes the stomach contents towards the oesophagus which can cause reflux. Being overweight also weakens the lower oesophageal valve, thus increasing one’s risk of having reflux.
Do not eat three hours before bedtime
Gravity makes it easier for digestive juices to trickle from the stomach into the oesophagus when you lie flat. Do consider raising your head when you lie in bed if you have reflux. If you sleep with a partner, you can purchase a wedge to sleep on which would raise just your side.
Improve vocal technique
Heavy voice users should learn and practice proper voice projection techniques and ways to minimise the strain on the voice box while delivering a clear voice quality. Speech therapists can help with this.
Source: Dr David Lau, a senior consultant at the department of otolaryngology at Singapore General Hospital and Ms Wong Seng Mun, a senior speech therapist at SGH
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