Stress, Tension, and the Voice

Emotional or physical stress can cause unconscious tension in the muscles that support and produce the voice. This may lead to:

• Muscle Tension Dysphonia (MTD): A condition where excessive tension disrupts normal voice production.
• A tight, strained, or breathy voice.
• Vocal fatigue or discomfort with use.
• Difficulty with vocal control or range.

Stress may also increase habits like throat clearing, shallow breathing, or speaking from a “high” place in the throat—all of which can compromise voice quality.

Performance anxiety can cause:

• Physical tension in the jaw, neck, and shoulders.
• Shallow or irregular breathing.
• Voice instability, tremor, or “cutting out.”
• Mental distraction or self-consciousness that disrupts vocal focus.

While some anxiety is normal, unmanaged stress can undermine even the most trained voice.

Tip: Preparation, warm-ups, and regular relaxation strategies can help reduce performance-related stress over time.

Chronic muscle tension can interfere with healthy voice production. Regularly practising gentle release techniques can help:

• Jaw massage: Use circular motions at the jaw joints and cheeks.
• Tongue stretches: Gently stick the tongue out, move side to side, and roll it in circles.
• Neck stretches: Slowly tilt and rotate the head, keeping shoulders relaxed.
• Shoulder rolls and chest opening: Improve posture and reduce upper body tightness.

Tip: Incorporate these into your daily warm-up or cool-down routine.

Managing stress holistically benefits your voice. Mindfulness and relaxation techniques can support both mental focus and muscle release.

• Diaphragmatic breathing: Deep, steady breaths that support vocal grounding.
• Progressive muscle relaxation: Tense and release different muscle groups to build body awareness.
• Guided meditation: Helps reduce anxiety and promote calm before performance or teaching.
• Mindful movement (e.g., yoga, Alexander Technique, Feldenkrais): Enhances physical alignment and breath support.

Even a few minutes a day can lead to noticeable improvements in vocal comfort and clarity.

Challenge | Strategy

Voice tension or strain | Use gentle release techniques for jaw, neck, and tongue

Anxiety before performing or speaking | Try mindfulness and breath-based calming techniques

Muscle tension in body or face | Regular stretching, massage, and posture checks

Fatigue or instability | Prioritise rest, hydration, and consistent warm-ups

Stress is part of life, but with the right tools, you can protect your voice and perform at your best—even under pressure.

Why It Matters?

• The vocal folds rely on good hydration to stay flexible and vibrate efficiently.
• Certain foods and drinks can either support or interfere with vocal performance.

Key Tips:

• Drink plenty of water throughout the day—aim for at least 6–8 glasses.
• Eat a balanced diet rich in fruit, vegetables, whole grains, and lean protein.
• Include foods that naturally support hydration, like cucumber, melon, and broth-based soups.
• Limit processed and salty foods that can be dehydrating.

Note: Surface hydration (via steam or nebulisers) can also help soothe the throat and vocal folds, especially in dry environments.

What you eat just before using your voice matters—some foods can cause mucus, dryness, or reflux that interferes with vocal function.

• Spicy foods – can irritate the throat and increase acid reflux.
• Acidic foods – like citrus, tomatoes, and vinegar can trigger reflux.
• Fried and fatty foods – slow digestion and increase reflux risk.
• Chocolate – can relax the esophageal sphincter and promote reflux.
• Cold dairy – may thicken mucus for some people, though effects vary.

Tip: Try eating lighter, non-irritating meals before voice use—think steamed vegetables, lean proteins, and room-temperature water.

Some medications can be helpful—but others may dry the voice or mask important symptoms.

• Antihistamines (for allergies): Can reduce post-nasal drip but may dry the vocal folds. Use newer, non-drying formulations when possible.
• Proton Pump Inhibitors (PPIs) (for acid reflux): Useful if you have signs of laryngopharyngeal reflux (e.g. throat clearing, lump sensation).
• Steroids: Occasionally prescribed for severe inflammation or urgent performance needs. Use only under medical guidance.
• Avoid overuse of throat lozenges with menthol or numbing agents, as they may encourage misuse by masking discomfort.

If you need to use your voice while still recovering:

• Reduce demands: Shorten sessions, take vocal breaks, and limit projection.
• Use amplification (e.g. microphone or voice amplifier) to reduce effort.
• Warm up gently and avoid any high-intensity vocal tasks.
• Speak clearly, at a moderate pace and volume.
• Use non-verbal communication when possible.
• Listen to your body—if your voice starts to feel strained or tired, stop.

Do | Don’t

Rest your voice as needed | Push through hoarseness

Stay hydrated and use steam or nebulisers | Whisper or speak forcefully

Use medications only when advised | Self-medicate with drying or numbing agents

Use a mic and reduce vocal load | Ignore signs of vocal fatigue or pain

Stress is part of life, but with the right tools, you can protect your voice and perform at your best—even under pressure.

LPR occurs when stomach contents—especially acid and enzymes—travel up the esophagus and reach the throat or larynx (voice box). Unlike typical reflux (GORD), LPR often doesn’t cause heartburn but may lead to:

• Hoarseness or voice changes
• Throat clearing or chronic cough
• A lump sensation in the throat (“globus”)
• Mucus or postnasal drip
• A sore or irritated throat
• Vocal fatigue

Because LPR symptoms can be subtle, it often goes undiagnosed without a specialist assessment.

When acid or pepsin (a digestive enzyme) reaches the larynx, it can cause inflammation, swelling, and damage to the vocal folds. This can result in:

• Loss of vocal clarity
• Reduced range or power
• Delayed voice onset (slow to start phonation)
• Increased effort to speak or sing
• Prolonged recovery after voice use

Repeated exposure can lead to chronic vocal fold irritation, increasing the risk of voice injury or persistent hoarseness.

Managing LPR begins with reducing reflux triggers. Helpful strategies include:

Dietary Adjustments:

• Limit acidic foods (e.g. citrus, tomatoes, vinegar).
• Avoid spicy, fatty, or fried foods.
• Cut back on caffeine, chocolate, alcohol, and carbonated drinks.
• Avoid eating 2–3 hours before bed.

Lifestyle Modifications:

• Elevate the head of the bed or use a wedge pillow.
• Avoid tight clothing around the waist.
• Maintain a healthy weight.
• Stop smoking.
• Reduce stress, which can exacerbate reflux.

Small, consistent changes can lead to significant voice improvements.

Medication Options:

• Proton Pump Inhibitors (PPIs): Reduce stomach acid production (e.g., omeprazole, esomeprazole).
• H2 Blockers: Another class of acid-reducing drugs (e.g., ranitidine, famotidine).
• Alginates and Antacids: Provide short-term relief by neutralising or blocking reflux.

Always consult your doctor or ENT before starting any reflux medication.

Voice Care Tips with LPR:

• Avoid excessive throat clearing or coughing.
• Use steam inhalation to soothe irritated tissues.
• Follow a structured voice therapy program if needed.
• Rest the voice if hoarseness or fatigue occurs.
• Stay hydrated to help protect and heal the vocal folds.

Focus Area | Key Advice

Symptoms | Look out for subtle voice changes, throat clearing, or chronic irritation

Diet | Avoid acidic, spicy, and fatty foods; eat earlier in the evening

Lifestyle | Elevate your head at night, reduce stress, avoid tight clothing

Medication | Use under guidance from a healthcare provider

Voice Care | Stay hydrated, reduce strain, seek voice therapy if needed