The Throat

The laryngologist answers your questions
By Dr. Françoise Chagnon*

Why is smoking harmful for the voice as well?

Cigarette smoke doesn’t merely kill smokers themselves; it also destroys their voice. There is countless scientific research that links smoking to cancer of the mouth, of the throat, of the lungs and of the oesophagus. The risk of contracting cancer of the larynx is twice as high in subjects who smoke more than 20 cigarettes a day. The risk becomes even greater when tobacco smoking is combined with alcohol consumption; these two substances act in synergy in a way.

It isn’t the nicotine that causes the cancer, but rather the tar. Indeed, this mixture of polycyclic aromatic hydrocarbons contained in the smoke is a highly carcinogenic substance. The heat produced by the smoke in the throat is likewise very dangerous. Pipe smoking and cigar smoking can also cause cancer of the mouth and of the throat, and are therefore not harmless substitutes for cigarette smoking.

Cigarette smoke causes an inflammation-like effect in the respiratory tract tissues: redness, swelling, increased mucus production, thickening of the mucus membranes. The particles of smoke and the heat from the inhaled smoke both seem to cause damage to the mucus membranes. It is interesting to note that non-filtered marijuana smoke causes even greater irritation to the throat and the trachea than tobacco smoke.

A laryngologist can recognise a smoker just from the appearance of his nose and throat: nicotine stains on the nasal hairs, drying out of the throat, dryness and inflammation of the vocal cords, thick secretions. Singers who smoke have a rough and husky voice, and their high notes lack clarity. The vocal cords of female smokers can be affected by large blister-like polyps and by severe degeneration. Those people who suffer from chronic inflammation linked to smoking often develop white plaques on the walls of the throat; this is known as leucoplakia, a precursory sign of cancer.

Smoking reduces respiratory capacity. As the bronchial tubes contract, the quantity of air going in and out is reduced, and this in turn affects vocal emission. Organic upheaval inflicted on the respiratory tract cannot be corrected, even by the very best vocal technique – however impressive this technique may be. If pianissimo singing is to reach the back row of a concert hall, the sound emitted has to be clear and well projected; this is an almost impossible task for a smoker who is gasping for breath. Obviously, very few singers of classical music choose to smoke. However, certain rock and pop vocalists use smoking to create a vocal effect that fits in with their repertoire style. Similarly, certain female blues or soul singers believe that smoking helps them to produce a deeper voice that suits their style of music. But this choice means that there is a price to pay as well. Indeed, emphysema, bronchitis, repeated throat infections and even cancer have brought an early and tragic end to many a vocal career.

The damage caused to the vocal cords can even last after the person has given up smoking and may in some cases be irreversible. Minor swelling can take six to nine months to reduce, while more serious inflammatory lesions may sometimes require surgical intervention. Smoking is one of the major causes of resistant nodules, which are prevented from healing by constant irritation of the throat. Even surgery does not provide the guarantee of a cure or the guarantee that the voice will be recovered.

Singers who ply their trade in smoky nightclubs can also suffer the same effects. When it is impossible to avoid these situations, non-smoking singers can compensate by drinking a lot of water and by breathing in fresh air between each performance that they give.

In conclusion, then, those singers who take a pride in their art will be well rewarded if they take great care of their vocal equipment, namely their throat and their vocal cords. Indeed, if appropriate care is taken, the gift of the human singing voice can last a lifetime.

Françoise P. Chagnon is the director of the Voice Laboratory of Montreal General Hospital