I am a 48-year-old Caucasian female who stopped smoking four weeks ago. I used to smoke two packs of cigarettes a day for 12 years. I stopped because I wanted to start singing in my choir again, but I can't get a clear tone to come out. Have I permanently damaged my voice from smoking, or is my body getting used to not having to deal with smoke? What remedies can I do to bring back that clear tone?

N.

Congratulations on giving up cigarettes! Nicotine is one of the most addictive drugs known, which is why quitting is so fiendishly difficult.
Cigarette smoke is an irritant. By smoking so heavily, you bathed your vocal cords in this irritant during every waking hour for 12 years. As a result, you have (at the very least) swelling of the vocal cords. Swelling (the medical term is "edema") is an increase in the water content of a tissue. With vocal cords, swelling increases the weight of the cords and thus changes the voice's pitch. Think about guitar strings -- the heavier the string, the lower the pitch when the string vibrates. However, unlike a heavier guitar string, your vocal cords were not designed to vibrate at this lower frequency. The usual result is not just a deeper voice, but a less clear ("husky" or "throaty") voice.

You may also have a condition in which stomach contents (acid and digestive enzymes) flow back toward the throat while you are asleep. When this so-called "reflux" occurs into the esophagus, the condition is known as gastroesophageal reflux disease (GERD). When reflux occurs into the throat, the condition is called laryngopharyngeal reflux disease (LPRD). Most people with LPRD do not have heartburn and are usually surprised when their doctor tells them that this is their problem. LPRD can cause persistent throat-clearing, change in voice (including hoarseness) and cough. Many ear, nose and throat specialists also think that LPRD contributes to sinusitis and ear infections.

I mention LPRD because it is very common and often goes undiagnosed -- many clinicians are stuck on the incorrect "no heartburn, no reflux" concept. If you have LPRD, the refluxed acid and digestive enzymes have been acting as co-irritants with the cigarette smoke. Even though you quit smoking, reflux will continue to contribute to your vocal-cord edema.

Edema is a stubborn problem. Some forms of vocal cord edema even require surgical treatment. If you have LPRD, you may need to be aggressively treated for six months or more before the inflammation resolves. Aggressive treatment consists of lifestyle and dietary changes and treatment with a drug known as a proton-pump inhibitor.

You should try to find an ear, nose and throat specialist (ENT) with experience treating voice disorders (which most ENTs have). The ENT will examine your vocal cords with a flexible fiberoptic telescope. This examination is a simple, usually painless office procedure. LPRD, the severity of your vocal cord edema, vocal polyps, nodules and cancers can all be diagnosed by this procedure. Certain conditions respond well to voice therapy, others to medical therapy. Some require surgery.

Is your voice permanently "broken?" Maybe, but it is too early to tell, especially since you have not been appropriately examined. As indicated above, treatment may take six months or more.

Is there anything simple that you can do to improve your voice? Stay well hydrated by drinking plenty of non-alcoholic, non-caffeinated beverages, and do not abuse your voice. Yelling, whispering, and excessive throat clearing abuse the voice. Even choir singing can abuse the voice, if you are not an experienced singer. A professional voice coach or speech therapist can teach you how to sing without straining your voice.