Intended for healthcare professionals


Managing dysphonia caused by misuse and overuse

BMJ 2000; 321 doi: (Published 23 December 2000) Cite this as: BMJ 2000;321:1544

Accurate diagnosis and treatment is essential when the working voice stops working

  1. Paul Carding, senior lecturer in voice pathology (,
  2. Andrew Wade, head of voice department
  1. University of Newcastle upon Tyne and Freeman Hospital, Newcastle upon Tyne NE7 7DN
  2. Royal Shakespeare Company, Stratford upon Avon CV37 6BB

Actors in the Royal Shakespeare Company are trained to use their voices with consummate skill to express any range of emotions in the most demanding of circumstances.1 Yet the demands of professional performers' lifestyle and work will expose them to many dangers that may jeopardise their most valuable instrument of expression.2 Similar risks may affect teachers, clergy, lawyers, operators at call centres, and others who require the use of their voice to maintain their income. For actors and singers, even a brief period of dysphonia may be artistically or aesthetically devastating. 2 3 For other professional voice users, chronic or recurring dysphonia may have severe career and economic consequences.4

Major risk factors for laryngeal problems include smoking, excessive alcohol consumption, and gastro-oesophageal reflux (often caused by poor dietary habits).3 The main risk factors for non-organic dysphonia include excessive use of the voice, limited vocal recovery time, and stress.5 The effects of overuse of the voice are …

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