In this article, you’ll learn all about good vocal hygiene, including a protocol to stop chronic throat-clearing.
Plus, download our free vocal hygiene speech therapy checklist!
Visit our shop for more evidence-based speech therapy handouts and treatment guides.
What is Good Vocal Hygiene?
Good vocal hygiene is a set of behaviors that optimize vocal health and voice production.
This means avoiding behaviors that irritate or even damage the voice. While adding behaviors that support a healthy voice.
Studies show that non-medical voice treatment that includes vocal hygiene may improve vocal quality and treat vocal fold nodules (Mansuri, 2018).
Keep scrolling to learn how to teach vocal hygiene to your speech therapy patients.
Why Is Vocal Hygiene Important For Speech Therapy?
Some of your patients may only need vocal hygiene education to improve their vocal quality while others will need a combination of vocal hygiene, voice exercises, and other interventions to improve their vocal quality.
Here’s a metaphor you can share with your patients:
Let’s compare a voice to having a car. Your car is a machine that needs to be taken care of to run properly. This care includes regular maintenance (getting car washes and oil changes) and avoiding dangerous situations (not driving aggressively).
But having a car also entails good daily habits, like following traffic rules and parking in between the lines, in order to continue working smoothly and looking good.
Your voice is similar as it needs regular maintenance (vocal rest) and avoiding certain situations (no shouting). And it also needs good daily habits, like plenty of hydration and speaking in an easy way to continue working smoothly and sounding good.
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Who Needs Vocal Hygiene?
Most people would benefit from good vocal hygiene—including speech-language pathologists!
In your practice, consider teaching vocal hygiene to patients who use their voices a lot or who have conditions impacting their vocal health.
And you may even adopt a few tips for yourself!
Who needs vocal hygiene?
- Voice disorders
- Professional singers
- Teachers
- Cheerleaders, coaches, referees, umpires
- Religious leaders (rabbis, imams, ministers, etc.)
- Actors
- Vocal hoarseness or fatigue
- Symptoms of glottal fry
- Vocal nodules
- Neurological conditions that affect the voice
- GERD/LPR
- Reinke’s edema
- Muscle tension dysphonia
- Living in drier climates
- Prone to dehydration
- Autoimmune diseases that affect the voice
- Certain medications (antihistamines, inhalers, etc.)
- Aging voices
- Vocal trauma or acute respiratory illness affecting the voice
- COPD and other respiratory conditions
How To Teach Vocal Hygiene
Use the vocal hygiene checklist to treat the underlying behavior(s) causing a person’s voice disorder.
For one patient, poor breath support may be causing vocal strain. While for another, chronic throat clearing adds to their vocal fold damage.
As always, start with a thorough assessment including a case history that includes information about their job, environments, current or recent stressors, and history of voice issues.
Then make a great treatment plan. During treatment, teach your patient to do less of the damaging behaviors and more of the healthy ones.
Here’s how.
- Find the cause. First, help your patient identify the key behavior(s) causing their voice disorder.
- It may be related to job, lifestyle, illness, climate, etc.
- Educate. Use visual aids to explain how this behavior affects their vocal anatomy and physiology.
- Find triggers. Next, help them identify any personal triggers for the damaging behavior.
- For example, the end of the day, when tired, when stressed, in certain postures (twisting at the chalkboard), allergy season, winter, etc.
- Improve self-awareness. Help patients identify when the damaging behavior is happening in the session.
- Then help them carry over this self-awareness into daily life.
- Add healthy behaviors. Introduce healthy behaviors to replace or modify the damaging ones.
- Practice in a variety of speaking settings to encourage carryover (waiting room, cafeteria).
Vocal Hygiene Speech Therapy Checklist
Use the Vocal Hygiene Checklist to help patients avoid vocal fold damage or to heal after damage.
Preparing To Speak
- Upright posture of the neck and spine
- Relax the upper body
- Face the listener
- Reduce background noise
- Improve lighting
While Speaking
- Talk at a moderate volume and length
- Overarticulate
- Speak slower with longer pauses
- Use breath support (ease into the start, picture the breath powering the voice)
- Avoid whispering (use ‘confidential voice’)
- Avoid yelling (gesture, wave, ring a bell)
- Use a personal amplifier
Environment & Daily Life
- Hydrate throughout the day
- Eat a balanced diet
- Get enough sleep
- Avoid smoking
- Avoid alcohol & caffeine (if not, drink even more water)
- Avoid coughing & throat-clearing (more on how below)
- Avoid airborne irritants (allergens, smoke, cleaning agents. Use an air purifier)
- Use a humidifier (30% humidity)
- Vocal rest when needed (tired, sick, throat pain, sore throat, dry throat)
- Check medication side effects for throat dryness (decongestants, antihistamines, etc.)
(Stemple 2018; Watts 2019)
Vocal Hygiene Goals
- The patient will demonstrate no throat clearing during a 30-minute time period to improve vocal quality with moderate cues in 2 weeks.
- The patient will be able to utilize proper vocal hygiene during conversation 80% of the time with mild cues in 4 weeks.
- The patient will independently recall 100% of their vocal hygiene strategies in 2 weeks.
For more speech therapy goals visit the Goal Bank for Adult Speech Therapy.
How To Avoid Throat-Clearing
Throat clearing is a common habit that can be hard to break.
Clearing the throat too often can injure the vocal cords, which can lead to hoarseness and breathiness. Over time, chronic throat clearing can cause dysphonia.
Studies show that vocal hygiene education that covers throat-clearing improves voice quality in people with voice disorders (Vertigan, 2006).
Here’s a sequence to follow to reduce throat clearing:
- If you feel the need to clear your throat, take a sip of water or do a dry swallow.
- Then do a HARD swallow, like swallowing a whole grape.
- If you still feel the need to clear your throat, do a silent /h/ cough instead.
- Take another sip of water.
Other ways to avoid throat clearing:
- Take small sips of water
- Pant lightly, then swallow
- Soft hum
- Gentle laugh, then swallow
- Suck on hard candy or chew gum (sugar-free)
(Williamson, 2014; Sataloff, 2018)
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References
- Mansuri, B., Tohidast, S. A., Soltaninejad, N., Kamali, M., Ghelichi, L., & Azimi, H. (2018). Nonmedical Treatments of Vocal Fold Nodules: A Systematic Review. Journal of voice : official journal of the Voice Foundation, 32(5), 609–620. https://doi.org/10.1016/j.jvoice.2017.08.023
- Sataloff, R.T. (2018). Treatment of Voice Disorders (2nd ed.). Plural Publishing, Inc.
- Stemple, J. C., Roy, N., & Klaben, B. K. (2018). Clinical Voice Pathology: Theory and Management (6th ed.). Plural Publishing, Inc.
- Vertigan, A. E., Theodoros, D. G., Gibson, P. G., & Winkworth, A. L. (2006). Efficacy of speech pathology management for chronic cough: A randomised placebo controlled trial of treatment efficacy. Thorax, 61(12), 1065-1069. https://doi.org/10.1136/thx.2006.064337
- Watts, C.R, & Awan, S.N. (2019). Laryngeal Function and Voice Disorders Basic Science to Clinical Practice (1st ed.). Thiem.
- Williamson, G. (2014, September 2). Stop Throat Clearing! SLT Info. Retrieved January 18, 2024, from https://www.sltinfo.com/stop-throat-clearing/