How Does Frequent Shouting Contribute to Laryngitis?

Introduction

We have all grown up hearing, 'If you keep shouting, you’ll lose your voice,' or 'Lower your voice before you hurt your throat.' But is it possible to damage your throat or lose your voice from shouting?

The throat refers to your larynx or voice box, and it is possible to injure your vocal cords (vocal folds) by shouting or yelling, leading to inflammation or swelling of the larynx.¹ Therefore, vocal abuse, misuse, and overuse can cause acute non-infectious laryngitis or larynx inflammation.²

Read on to understand how shouting at a concert, singing, talking too much, speaking loudly, or even whispering for long durations may not be good for your larynx and contribute to laryngitis.

What is non-infectious laryngitis?

Laryngitis is the inflammation of the larynx or your voice box. Most often, viral and bacterial infections cause laryngitis or infectious laryngitis.

Inflammation of the larynx by factors other than infection is termed non-infectious laryngitis. Vocal trauma (phonotrauma), allergy, asthma, gastroesophageal reflux disease (GERD), pollution, and smoking are the common causes of non-infectious laryngitis.¹

Is non-infectious laryngitis an acute or chronic condition?

Irrespective of the trigger, for example, infectious or non-infectious, laryngitis is typically a mild condition that lasts briefly (acute) for 3 to 7 days.¹ Acute non-infectious laryngitis rarely requires medical intervention and can be managed through home remedies and self-care.

However, if the symptoms persist beyond 2 or 3 weeks, laryngitis is considered chronic (long-duration).^1,3 

Non-infectious laryngitis can become chronic if:^1,4

• Voice care is neglected
• Diet is unmodified
• Smoking or vaping is not controlled
• Medical intervention is not sought or ineffective

What is phonotrauma?

Phonotrauma is the medical term for vocal trauma. Vocal trauma is the injury to the vocal cords of the voice box (larynx) caused by vocal misuse, overuse, or abuse.⁵ Vocal trauma can cause laryngitis, vocal cord lesions, or vocal cord haemorrhage.² 

What counts as phonotraumatic behaviours that can cause laryngitis?

Phonotraumatic behaviours in children

Yelling, screaming, shouting, and mimicry while playing or otherwise are the key phonotraumatic behaviours that could strain or injure the vocal cords of a child.^5,6 A study in 2000 included crying as a phonotraumatic behaviour.⁷

Phonotraumatic behaviours in professional voice users (PVUs)

Professional voice users like singers, drama artists, teachers, salesmen, telephone operators, and numerous others are susceptible to phonotraumatic disorders.⁴ 

The occupational demand for daily voice use, especially shouting, loud voice usage, and voice modulation (pitch and intensity), leads to phonotrauma, suddenly or gradually.^8,9 Lack of knowledge in voice training and techniques also increases the risk of phonotrauma in PVUs.⁴

Additionally, throat-clearing and prolonged coughing are common phonotraumatic behaviours that could strain or irritate the vocal cords.¹⁰

How does shouting contribute to laryngitis?

Shouting, a phonotraumatic behaviour, can strain your vocal cords. Sudden or repeated strain on your vocal cord for a given period may lead to inflammation, causing laryngitis. 

How do your vocal cords work in normal voice production?

Your larynx or voice box has two small bands of tissues that stretch across the top of your windpipe. This pair of tissue bands is the vocal cords (vocal folds).

Normally, the air leaving your lungs blows between the vocal cords that open and close smoothly. The passing air vibrates the closed (adducted) vocal cords and generates sound waves that are fine-tuned to words by our jaw, tongue, and lips.

If you want to visualise the vocal mechanics, this animation by the NHS might help. 

What happens to your vocal cords when you shout?

Shouting is different from being loud. Unlike a loud voice, a shout is a sudden outburst. Shouting, influenced by emotion (joy, anger, excitement, fear, disgust) or the situation (like warning of danger), exerts extreme pressure on the larynx.⁸

Vocal cords of your larynx experience constant stress. However, over the period, vocal cords evolve to withstand the stress exerted during voice production. A threshold for tolerance forms depending on your age, health, and daily vocal use.¹¹

Shouting exerts pressure on your vocal cords beyond tolerance levels, inducing tissue injury.¹¹ The injured tissue triggers an immune response by releasing chemical signals. These signals prompt more blood supply to the injured area to promote healing.

Blood supply to the injured vocal cord(s) promotes:

• Nutrient supply
• Oxygen supply 
• Mobilisation of competent immune cells

The increased blood supply is why injured areas often become red and warm, typical signs of inflammation.¹²

An inflamed or swollen vocal cord(s) is prevented from coming together (adduction) and closing completely. The gaps due to swollen vocal cords cause the sound waves to distort when air passes over them resulting in a hoarse voice, a common symptom presented in laryngitis. 

How can laryngitis induced by phonotrauma be managed?

Behavioural changes, vocal hygiene, and vocal training can help prevent phonotrauma or laryngitis induced by vocal trauma.^4,5

Behavioural changes

Vocal health education, identification and altering of phonotraumatic behaviours are essential in eliminating the risk of vocal disorders.⁵ Habitual shouting behaviours should be modified for good vocal health. 

Vocal hygiene

Vocal hygiene involves a set of preventive and behavioural measures like lubricating, hydrating, and avoiding irritants (smoking, alcohol, and caffeine).¹³

Additionally, not talking loudly in noisy areas and avoiding self-medications, dry-air environments, or postures that exert muscle tension in your neck promotes good vocal health.¹⁴

Vocal training

Vocal training for PVUs teaches different breathing and vocal techniques and exercises to improve the working of vocal cords.¹¹

If you already have a hoarse voice after having cheered (shouted) at an event or shouted at someone, the following might help:^1,14

• Completely rest your voice by not speaking or singing for 3 days
• Upon a need to verbally communicate, avoid whispering and use a confidential voice (low volume) instead
• Inhale steam to moisten the upper throat and reduce mucus secretion
• Constantly hydrate yourself by taking small sips of water at room temperature 

If the hoarseness persists even after two weeks of self-care and home remedies, you should visit your ear, nose, and throat specialist (otolaryngologist) for accurate diagnosis and therapy.

FAQs

Why is vocal rest during laryngitis important?

Laryngitis is the swelling of vocal cords. The swollen vocal cords remain open when on vocal rest or when you don’t talk. When you want to converse, the swollen vocal cords close incompletely and vibrate inefficiently. Hence there is a changed voice with low power and sound.

Talking with swollen, inflamed vocal cords means forcing them to close, like trying to close a swollen door. Further, your lungs push out air with more pressure to compensate for the associated low vocal power and vibratory inefficiency. 

Therefore, talking during laryngitis would further strain your lungs and injure the vocal cords, resulting in delayed recovery. The vocal cord inflammation (swelling) may further develop into vocal cord lesions, with a more permanent change in voice quality.¹¹

My child is a habitual shouter and complains of throat pain afterwards. What should I do?

Throat pain after shouting indicates trauma or injury to the vocal cord of the voice box. If your child has a hoarse voice associated with throat pain, the shouting could have caused laryngitis. Voice rest, hydration and steam inhalation are the immediate remedies for laryngitis.

To minimise the recurrence, you may consult a speech-language pathologist/therapist to address and manage your child’s enthusiastic voice usage through voice therapy. 

How does drinking water help with laryngeal irritation?

Your vocal cords are lined with a mucous membrane that lubricates them. When you talk/sing continuously or loudly (even shout), your larynx dries up (dehydrates). As a response, the mucous membrane secretes excess mucus that is thick and sticky.¹¹ 

A thick and sticky mucus deteriorates lubrication of the vocal cords and incites vocal traumatic behaviours, coughing and throat-clearing. Sipping water (room temperature) or swallowing hard assists hydration and improves lubrication as the mucus becomes thin and watery.^13,14 

Summary

• Laryngitis is the inflammation (swelling) of the larynx or your voice box
• Laryngitis is typically a mild condition that lasts briefly (acute) for 3 to 7 days
• Shouting suddenly or repeatedly can exert a strain on your vocal cord beyond levels of tolerance, inducing tissue injury
• Injured vocal cords lead to inflammation, causing laryngitis
• Behavioural changes, vocal hygiene, and vocal training can help prevent vocal trauma-induced laryngitis