Does Smoking Affect the Voice?
“I smoke but not cigarettes.” I hear this constantly - an attempted reassurance based on an assumption that smoking weed or vaping is safer for the voice than cigarettes.
As a laryngologist (physician specializing in voice, preventative vocal care and vocal rehabilitation & surgery), I worry for the vocal health of voice athletes and vocal artists, especially with the impact on their work. I can’t help but foresee shorter careers, changing vocal ability, and irreversible injury.
A meta analysis published in Nature confirmed that smoking impacts the voice. The power of this study was to pool the results of ten quality studies to produce more accurate data.
They determined:
Image credit Donny Jiang @dotnny
Smoking lowers the pitch of the voice (fundamental frequency
Smoking lowers the maximum phonation time (the length of time you can make sound before needing to breathe again)
Smoking may cause voice disorders, such as cancer, although functional disorders (i.e., injury) were not clearly proven
Smoking can dry the vocal cord mucosa and irritate the vocal cords
Smoking causes vocal cord inflammation
Pulmonary function is weakened (breath supply and vocal power)
Of note, it is not the tobacco that is the culprit. It is the act of smoking, demonstrated in studies evaluating the effect of smoking, including marijuana as well. While we don’t have longevity for significant data on vaping as a newer modality of drug inhalation, it is likely there is some degree of the same effects.
The vocal cords are complicated structures. More accurately called “vocal folds” to emphasize their multi-layered complexity. When this delicate vocal cord system is exposed to toxins such as smoke or air pollution, the surrounding tissue swells. Swollen tissue, placed under the stresses of singing, projected voice (i.e., public speaking, voiceover), and acting, swells further, making it more prone to bruising and scarring. In some people, smoking thickens the vocal folds. When the vocal folds thicken, this results in lowering the pitch of the voice and potentially eliminating the top notes in a singer’s range. This change is usually irreversible and is what we think of when we note a “smoker’s voice.”
Smoking is common among vocal athletes for many reasons. It’s important to appreciate that it is the act of smoking, rather than the specific drug in it, that is causing the voice issues. This may help us to shift to safer methods of consumption, sparing the athlete from career-ending injury. I appreciate the reassurances I get in my office about what my patient is smoking - it suggests an attempt to make a better decision for their body while honoring their work and work environment.
My role as a vocal athlete’s specialized laryngologist has to be to advocate for vocal health and safety. Smoking cessation is a huge step for any patient wanting to shift in the right direction. Patches, gums, and edibles provide far safer options and increased longevity for their voice. While it may take some time to adapt, the benefits to performance will make it worthwhile.
Smoking Cessation Benefits:
At 1-2 weeks: reduced fatigue of the voice
At 3-4 weeks: improved vocal range
At 4 weeks: improved power and endurance
At 6 weeks: reduced need for vocal rest after performance, increased ability to perform with movement (dance, character acting)
At 8 weeks: improved sense of taste and smell
Did you find this article useful? Check out our handy infographic below for easy sharing.
References
Byeon, H., Cha, S. Evaluating the effects of smoking on the voice and subjective voice problems using a meta-analysis approach. Sci Rep 10, 4720 (2020). https://doi.org/10.1038/s41598-020-61565-3
Balouch B, Alnouri G, Valentino W, Sataloff RT, The Effect of Marijuana on the Voice: A Pilot Study, Journal of Voice, 2020