By Stephanie Ciccarelli
January 8, 2009
If you've ever smoked, do smoke or have quit, you know what cigarette smoking can do to your voice.
I had the privilege of attending and covering the Midwest Voice Conference and also the great pleasure of meeting and recently interviewing Dr. H. Steven Sims, a board certified Otolaryngologist and graduate of the Yale University School of Medicine. This interview poses questions about voice care and how cigarette smoking affects the voice.
Dr. Sims' personal experiences and education are employed to address the problems of performing artists and other voice professionals at The Chicago Institute for Voice Care, and is dedicated to increasing the awareness of the unique issues faced by performing artists and providing comprehensive care.
VOX: How does the speaking voice change when a person has been smoking for a period of time?
Dr. H. Steven Sims: I would be indulging in shameless hyperbole if I suggested that every person who ever smoked ruined their voice. Sarah Vaughan is still revered and envied because she did little to protect her voice, but was still able to sing.
That said, the vocal clarity of her youth went away and never really came back (Aretha Franklin had the same result). Typically, smoking creates chronic swelling (edema) on the vocal fold and not only does the voice become less clear, it becomes harder to vibrate the vocal folds and higher frequencies, so the pitch becomes lower as well. Even one cigarette slows down the movement of mucus across the vocal folds and makes a person more likely to have trouble with phlegm for a few days (not just the time while someone is smoking, but afterwards).
VOX: Does it "feel" any different when smokers talk? If so, what feels different, and do they need to compensate for anything to achieve a desired performance?
DR. SIMS: From what patients tell me, it typically feels like it takes more effort and they need to clear their throats more often. I don't think it necessarily hurts to talk or anything like that, but the reality is that cancer risk goes up so that if a smoker does begin feeling pain, the suspicion of cancer, and need to rule it out, are more acute than in a non-smoker. Also, many people feel a chronic "tickle" in the thoat.
VOX: What kind of challenges (due to cigarette smoking) are present in a voice over / singing career that are not present for non-smokers?
DR. SIMS: Back to my first answer. The vocal folds are more likely to be changed structurally. So, range will often be decreased, endurance will often be shortened, and clarity will often be eroded. Also, the chronically irritated throat is harder to work with. It's harder to do voice-over work with a chronic tickle. It's like playing with an instrument that is out of tune and needs to be constantly tuned during rehearsals and performances.
VOX: Have you ever had to scope vocal folds to assess damage for a voice performer that has needed to be repaired through rehabilitation or surgery? I've observed this procedure and am interested to know if this is a common procedure for voice artists who smoke or suspect nodes.
DR. SIMS: Sorry to refer to myself, but I'm going back to the second answer on this one. I think it is important for any person who relies on the integrity of their voice for livelihood to be scoped if there is vocal trouble. However, for the voice-over artists who smokes, it's more critical to rule out cancer. So, I have absolutely seen professionals who have experienced voice changes. Some have been diagnosed with cancer and some have had benign changes from smoking. I use laser surgery as well as delicate instruments under the microscope to repair damage as well as to remove cancers.
VOX: Could you please describe nodes for us? How do people get them and how would they know if they have them?
DR. SIMS: In crude terms, nodes or vocal nodules are like callouses. They are the product of repetitive injury and the vocal mucosa responds by thickening. As such, people get them by overusing/misusing/abusing their voices. Teachers and pastors are highly vulnerable. Typically, the first sign is a change in the quality or purity of the voice and loss of higher notes/upper register.
VOX: What can smokers do once they've quit to implement a voice recovery plan / schedule? To give us some perspective, please detail what a usual day be like for someone post-operation during recovery for vocal surgery.
DR. SIMS: These are actually very different. After vocal fold surgery (phonosurgery) patient are on strict voice rest for a week. This means no talking, no singing, no whispering, no sound, basically. After someone quits smoking, the physical changes to the vocal folds can take months to resolve. In both cases, however, I do recommend working with a speech pathologist to help the patient adjust to the changing structure of the vocal folds.
VOX: Are there any special warmups or rehabilitation practices for the voice, breathing, and or vocal mechanisms that you recommend?
DR. SIMS: This actually ties back into my sixth answer, there is a very long list of exercises and the discipline of speech pathology-voice rehab focuses on this. I can ask my speech pathologist what she uses most often, but I think they tailor each program to the individual. Basic things like breathing and word conservation (not rambling on and on until you run out of breath during a sentence) is always helpful.
VOX: How important is it that a former smoker's family takes an active, supportive role in their recovery?
DR. SIMS: Quitting smoking (like breaking any bad habit) is VERY difficult to do alone. The support of family and friends is essential. Ecclesiates 4:9-10 is really critical here. When we fall down, we need someone to help us get back up and two (or more) are really better than one when you go into battle!
VOX: In your opinion, what is the demand for the "smoker voice" or "whiskey voice" in today's society and in the commercial advertising world? Was it once in demand and the era has passed?
DR. SIMS: I think there is still a mythical belief that the husky voice is sexy. However, we've realized the outcome now. Jack Klugman's voice isn't so sexy now. In general, we are more aware of the extremely deleterious effects of smoking and this trumps the idea that a smoker's voice is sexy. Also, the demand has decreased as society's desire to support bad habits like smoking has decreased.
VOX: Can you give any examples of people who have quit smoking to save their careers? How did they quit, manage get through the first stages of being a non-smoker, and be smoke-free to this day?
DR. SIMS: I can't really give the example per se, but Barack Obama is easily the most recognized person struggling with kicking this habit. It is unclear if he's really "quit" but, he's trying because it just plain looks bad for the leader of the free world to be an open smoker. I think quitting is just so individual. I have patients who just decided they didn't want to do it anymore, quit and have bee smoke-free for decades now. Others constantly struggle and are vulnerable to relapses at really anytime. There's also the correlation between mental illness, addictive personality traits and cigarette smoking, so for some people the struggle is even greater. Mostly now, I think jazz and blues people are the ones who think a smokey voice is a good one.
VOX: Are there distinct differences between how people may have sounded as a smoker in the past as compared to how they would sound as dedicated non-smokers in their present? I'd like to use Don LaFontaine as an example here. He smoked earlier in his career and up until his death, had been smoke-free for nearly 20 years. As a voice doctor, how would you describe the difference in vocal quality, performance and or ability in a person such as Don LaFontaine who chose to stop smoking and enjoyed 20+ smoke-free years? Would his voice have changed at all?
DR. SIMS: This one's hard because we're comparing reality to speculation. It's possible that his voice wouldn't have deteriorated, but if one looks at Bette Davis, you can see how frail she appeared and how unpleasant her voice sounded in interviews she gave near the time of her death. I do think he's a good example of how clear the voice can become after a smoking history if the patients quits. Also, lung capacity is improved which improves endurance and the risk of heart disease is reduced which also just makes the person more likely to be able to perform longer.
VOX: What is the best thing a former smoker can do once they've quit to take charge of their voice in a healthy manner?
DR. SIMS: The best thing is quitting. However, it's great to look at diet and exercise to help undo the effects of a bad habit. Vitamins A, C, and E do help with reversing cancer risks. Also vegetable that have color, yellow, orange, green, and red tend to carry nutrients that one's body would love to have after being exposed to smoke (or, in general for that matter). Drinking plenty of water is always good and 20 minutes daily exercise helps condition one's body. I really tend to think of professional voice users and vocal athletes and approach health as an overall level of fitness.
VOX: Should people insure their voices? If so, how important to do you think it is for a voice actor or singer to insure their voice, and do you know of any cases where the insurance has actually come in handy?
DR. SIMS: I think the concept of insuring a body part is the product of a creative publicist. To explain, I think a performing artist who gets disability insurance is wise. I have disability insurance because if lost the use of my surgical skills, I'd still need to live, but one could state that I insured my hands. It's not accurate, but also not untrue. I think that's what many people are talking about when they say they "insured" their voice. That said, I do think disability insurance is a good idea IF loss of voice would mean TOTAL loss of income. It's important for people to remember that if you insure your voice, you have to pay a premium for that.
VOX: If someone would like to contact you, how would you prefer they do that?
DR. SIMS: www.ChicagoVoiceDoc.com or firstname.lastname@example.org . They can also call 312-996-6555.
Click on the following link for more information about the upcoming Midwest Voice Conference in Chicago.
Looking forward to hearing your thoughts!
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