Philadelphia Ear, Nose and Throat Associates: PENTA

Laryngitis

  Does voice rest help laryngitis?

Voice rest (absolute or relative non-speaking) is an important therapeutic consideration in any case of laryngitis. When no professional commitments are pressing, a short course (up to a few days) of absolute voice rest may be considered, as it is the safest and most conservative therapeutic intervention. This means absolute silence and communication with a writing pad or other assistive device. The patient must be instructed not even to whisper, as this may be an even more traumatic vocal activity than speaking softly. Whistling through the lips also requires vocal fold motion and should not be permitted. Absolute voice rest is necessary only for serious vocal fold injury such as hemorrhage or mucosal disruption. Even then, it is virtually never indicated for more than 7 to 10 days. Three days are often sufficient. In many instances of mild to moderate laryngitis, considerations of finances and reputation mitigate against a recommendation of voice rest in professional voice users. In advising performers to minimize vocal use, Dr. Norman Punt of London, England used to counsel, "Don't say a single word for which you are not being paid." His admonition frequently guides the ailing voice user away from pre-performance conversations and post-performance greetings. Patients with such vocal problems should also be instructed to speak softly (not whisper), as infrequently as possible, often at a slightly higher pitch than usual and with a slightly breathy voice; to avoid excessive telephone use; and to speak with abdominal support as they would in singing. This is relative voice rest, and it is helpful in most cases. An urgent session with a speech-language pathologist is extremely valuable in providing guidelines to prevent voice abuse. Nevertheless, the patient must be aware that some risk is associated with performing with laryngitis even when voice use is possible. Inflammation of the vocal folds is associated with increased capillary fragility and increased risk of vocal fold injury or hemorrhage. Many factors must be considered in determining whether a given voice commitment is important enough to justify the potential consequences.