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The link between voice use and throat clearing

Do you know how voice use and throat clearing are linked?

I’ve seen many patients whose throat clearing is actually directly related to how they use their voice. They typically have a rough voice quality, strain, reduced efficient airflow or reduced forward resonance.

What’s going on here?

The sensation of inefficient phonation at the larynx is recognized and prompts the hypersensitive response cycle of needing the throat clear to remedy that sensation. And we know that throat clearing Will only lead to more throat clearing in this perceptual throat clearing cycle.

So how do we know if their throat clearing is truly caused by the way that they use their voice?

One key factor that I always note with these patients is if they say that their throat clearing tends to get worse with more speaking or at the end of the day after they’ve been speaking for a longer time. Usually they will not recognize this link until you directly ask these questions. Even then, it will take some education and direct demonstration to get the patients buy in that the way they use their voice can actually illuminate their throat clearing. Have them use resonant voice for 5 mins and notice the significant decrease in throat clearing - tada! BUY IN, baby and bye bye throat clearing (well if only it was THAT easy).

What do we do?

- Education

- Resonant voice and flow to re-establish efficient phonation patterns

- Work to generalize

- Replace current throat clearing behavior with an alternative behavior (like a swallow)

- Address anything else that underlies the voice and throat clearing issues (glottic insufficiency? Reflux? Poor vocal hygiene?)

Case example ; I had a Lung transplant patient feeling excessive throat clearing and extreme vocal fatigue and discomfort with speaking rough voice and feeling like he needs to stop conversations early. We worked on identifying the cause of his persistent throat clearing: one of them being the way that he is speaking and using his voice with little breath support (no surprise there), little forward resonance and low pitch. We did 15 minutes of education and work on resonant voice And shortly after that he experienced a significant decrease in throat discomfort as well as throat clearing and felt that his voice was so much easier to use in a continued conversation. He was shocked (I wasn’t) and motivated to practice and keep using resonant voice!

What have you noticed with these chronic throat clearing and voice patients?

If you're a person with a voice disorder have you noticed more throat clearing when you talk?

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