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Joan Rivers' Death: Facts About Vocal Cord Surgery

Older people often have vocal disorders, so here's how to protect your voice

Comic Joan Rivers’ raspy voice was as much her trademark as were her acerbic wit, platinum wigs and famous red carpet query “Who are you wearing?”

But it could also have been a sign of strained or damaged vocal cords, a not-uncommon occurrence for people who talk for a living and for boomers whose voices show signs of overuse, stress or aging.

Rivers died Sept. 4, a week after going into cardiac arrest while having elective throat surgery at a New York City outpatient clinic.

(MORE: Can We Talk About Joan Rivers?)

Who Has Vocal Cord Problems

Sources told TMZ that Rivers, who was 81, was at the clinic for an outpatient procedure to repair her vocal cords. However, the exact nature of the procedure she had isn’t clear, her autopsy was inconclusive and New York state health officials are investigating.

If Rivers was having surgery to treat damaged vocal cords, it wouldn’t surprise ear, nose and throat doctors who see patients like her all the time. Entertainers, teachers, cheerleaders, salespeople and other people who sing or talk for a living are more likely to develop calluses or nodules on their larynx, or vocal cords, from constant overuse, which gives their voices that distinctive raspy sound.

On the opposite end of the spectrum, older people who don’t talk enough can see their vocal cords atrophy, becoming smaller and weaker from disuse. Without sufficient bulk, the cords can’t meet in the middle to produce the vibrations that cause sound, which creates the characteristic “old person” voice, says Dr. Christopher Y. Chang, an otolaryngologist with Fauquier Ear Nose & Throat Consultants of Virginia.

Surgery is an option for over- or under-used vocal cords, but it’s not the only one. People also can regain a more normal-sounding voice through formal or informal voice therapies, everything from working with a speech therapist to taking singing lessons.

The Effect of Voice Disorder on Your Life

Sounding vital — and younger — isn’t just vanity. It can also affect communications and quality of life. Close to a third of people 65+ reported having some type of voice disorder, and nearly half (47 percent) said they’d experienced some type of voice disorder in the past, according to a 2007 report in the medical journal Laryngoscope. “Voice-related effort and discomfort, combined with increased anxiety and frustration and the need to repeat oneself, were specific areas that adversely affected quality of life,” the report says.

Overuse causes calluses, or nodules, to form on the delicate folds of the vocal cords. If non-surgical therapies fail, doctors can thread an endoscope through a patient’s nose and into the throat to inject a steroid into the vocal cords to help shrink the nodules, or in severe cases, remove them, Chang says.

For boomers whose vocal cords have atrophied, doctors can inject a tiny amount of collagen, fat or other gel filler, a process that takes about 15 minutes, is covered by many insurance plans and lasts up to six months, Chang says. Patients typically regain a normal or near-normal voice in a day or so, he adds.


(MORE: How to Manage Hearing Loss)

4 Ways to Protect Your Voice

Here are four things you can do to strengthen your voice on your own:

1. Pay attention to how you talk. Keep the vocal tract — the path from your lips to your vocal cords —  open and relaxed. Barbie Scott, a Portland, Ore., voice coach and speech pathologist, teaches clients to feel words resonate in the mask of their face, the circular area from the bottom of the nose to the chin, instead of the back of their throats, which causes strain. Hit the sweet spot, “and the mask will hum,” she says.

2. Use your whole body. Opera singers can sing hours a day year after year and still produce beautiful sounds because they use their diaphragm and chest to support their voice, not their throat, Chang says.

3. Sing. You don’t have to be a professional for crooning to help your voice — even singing in the shower counts. If you join a group or take lessons, look for a coach or choral director who emphasizes proper vocal technique. Get recommendations from a music conservatory, speech pathologist, or ear, nose and throat doctor.

4. Practice. Getting better takes daily practice, or for some people, practicing multiple times a day. Recognize how new techniques feel in your vocal cords, neck and jaw. Practice often enough, and eventually those techniques will become your new way of talking, Scott says.

Michelle V. Rafter is a freelance journalist whose work has appeared in such publications as The Wall Street Journal, MSN Money, and

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