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How Does Smoking Affect the Voice?

Smoking kills both smokers and their voices. Countless scientific reports have established the causal connection between tobacco smoking and cancer of the mouth, throat, lungs, and esophagus. The relative risk of developing cancer of the larynx is doubled in those who smoke more than 20 cigarettes a day. Alcohol and tobacco appear to act synergistically to elevate this risk still further.

It is not the nicotine in tobacco which causes cancer. Tobacco smoke is dark with tar -- a mixture of polycyclic aromatic hydrocarbons that is markedly carcinogenic. The heat of the smoke in the throat is dangerous as well. Pipes and cigar smoking are not harmless substitutes for cigarettes, since they too cause cancer of the mouth and throat.

In the tissues of the respiratory tract, cigarette smoke provokes effects similar to those of inflammation: redness, swelling, increased mucus production, and thickening of the surface lining or mucosa. Both the smoke particles and the heat of the inhaled fumes appear to damage the mucosa. Interestingly, unfiltered marijuana smoke causes even greater irritation to the throat and trachea than does tobacco smoke.

A laryngologist can recognize smokers just by the typical appearance of their nose and throat: nicotine staining of the nasal hairs, dry throat, dry swollen vocal cords, and tenacious secretions. Singers who smoke have a harsh breathy voice and a loss of clarity in their upper range. Women who smoke may suffer from polyps on their vocal cords and severe degeneration, polyps which have the appearance of big balloon blisters. Persons with chronic smoking-related inflammation often develop leukoplakia, or white patches on the lining of the throat, a known precursor of cancer.

Smoking also reduces normal breathing capacity. The decrease in air flow due to bronchial constriction impairs vocal performance, and such organic changes to the respiratory tract cannot be overcome by heroic singing technique alone! Smokers cannot expect to produce a clear ringing pianissimo that will reach the far corners of a hall. Obviously, very few singers of the classical repertoire choose to smoke. Some rock and pop singers do use smoking to create a characteristic vocal quality that fits this repertoire. Some women find that deepening their normal vocal range is well suited to a blues or soul sound. The cost of this choice is high, however. Emphysema, bronchitis, recurrent throat infection, and sometimes cancer have brought numerous singing careers to an early and disquieting end.

The damage to vocal cords may not completely heal even after the smoking has ceased. Mild swelling may take six to nine months to resolve and the more significant inflammatory lesions may require surgery. Smoking is a major cause of refractory vocal nodules, since constant irritation in the throat prevents them from healing. Even with surgery there is no guarantee of recovering a desirable singing voice.

Singers who perform in smoke-filled clubs may also suffer some of the same effects. When it is not possible to avoid such situations, non-smoking performers should compensate for them by increasing their water intake and going out for fresh air between sets.

Finally, all serious singers learn how to give meticulous care to their complete vocal instrument, i.e. to both vocal cords and throat. Such attention is usually rewarded many times over. With appropriate care, the gift of voice and song may indeed endure the whole life long.

Françoise P. Chagnon is the Director of the Voice Lab at the Montreal General Hospital

Advice on Quitting Smoking

Smoking is more an addiction than a bad habit, and quitting often requires more than a strong will. Smoking cessation programs today include a variety of medical treatments, from anxiolytics that control withdrawal anxiety and reduce insomnia to transdermal nicotine patches that smooth out metabolic readjustments. Fortunately smokers who successfully quit but later relapse will find it easier to quit the second time.

The advice here is: smokers, study your options! Cut down now on the number of cigarettes you smoke each day. Identify the times when you smoke to calm your nerves, to satisfy peer pressure, or just for no apparent reason. Choose a program to cure you of your addiction. Treat tobacco as you would cholesterol-rich food or hard liquor: use it very occasionally if at all, and certainly not every day.

Dr. Chagnon