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Are Video Calls Straining My Vocal Cords?

Updated on Jun 30, 2022 | Ear Nose Throat, Speech Pathology, Your Health

Unless you are a performer or your job requires you to talk a lot, you probably do not give much thought to your vocal health. However, vocal cord damage is more common than you may think as it affects as many as nine percent of adults nationwide. And, experts say the increase in video and phone chatting during the COVID-19 pandemic will only make matters worse.

Sarah Brown, MS, CCC-SLP, a speech-language pathologist at the Grabscheid Voice and Swallowing Center of Mount Sinai, has seen a marked increase in the number of patients with vocal strain or fatigue over the past six months.

“People tend to speak louder on video or phone calls when they think they can’t be heard well. Over time, this can set someone up for a vocal injury,” she explains. “On the other side of the coin, elderly patients who are not talking as much during the pandemic, are losing vocal stamina.”

To help patients prevent vocal cord injury, Ms. Brown explains how the injury occurs and provides tips for proper ‘vocal hygiene.’

What causes injury to the vocal cords?

The vocal cords are two bands of elastic muscle tissue located in your larynx, or voice box, that join together to form a V-shape. These cords, which are about the length of your thumbnail, are constantly at work—they come together and vibrate when you speak and open up each time you breathe.

Like other parts of the body, your vocal cords are prone to wear and tear. The area that is most susceptible to damage is the outer layer of the vocal fold, called the epithelial layer or the muscosa of the vocal fold. When the cords rub together too hard, or for too long, the tissue becomes damaged. The most common vocal cord injury is a benign mucosal lesion—a callus-like growth also referred to as nodule, polyp, or cyst.

Who is at risk of vocal cord injury?

While anyone can injure their vocal cords, it is more common in certain careers.

“Vocal damage can occur anytime you take your voice past the realistic limits of what it can do,” explains Ms. Brown. “It is like when you repetitively lift weights or wear uncomfortable shoes and then develop a callus on your skin.”

Ms. Brown treats many performers, news anchors, teachers, and lawyers who sing or talk all day at work. She also sees a lot of parents with big families and young people who yell or raise their voice often.

How do you prevent vocal cord injury?

If you are at risk of vocal strain, Ms. Brown recommends that you establish adequate ‘vocal hygiene’ by abiding by the following:

Use an efficient speaking voice. Adequate breath support allows for your voice to resonate well. Try to avoid excessive glottal fry, also known as vocal fry, especially when projecting.
Stay hydrated. Vocalists have a phrase, “sing wet and pee pale.” Drink two to four liters of water each day for optimal vocal health. As a result, urine should be light and odor-free.
Limit substances. Do not smoke cigarettes and limit alcohol use as both can dry out the vocal cords, increasing your risk for vocal injury. Excessive amounts of coffee, and other caffeinated beverages, can also lead to vocal dryness. If you are a multi-cup-a-day coffee drinker, make sure you compensate by drinking extra water.
Exercise regularly: Cardio and strength training helps maintain stamina. Don’t hold your breath when lifting! Use proper breathing techniques when hoisting weights.
Stop behaviors that increase vocal strain. Avoid excessive yelling, screaming, or talking; beware of noisy environments such as bars and restaurants; and limit throat clearing and coughing.
Warm up and cool down. Learn exercises to safely start and stop prolonged vocal use such as resonant humming, lip trills, and straw phonation.
Take breaks. During peak vocal demand, take six vocal naps—a 15 to 30 minute period of vocal rest—throughout the day.
Use appropriate audio set up for video calls. A combination of headphones and microphone will ensure that you can hear yourself and your speaking partner clearly so that you don’t speak excessively loud.

For more vocal health information from Ms. Brown, follow her on TikTok @vocalhealth and Instagram @vocalhealthskb. If you would like to see a medical professional regarding vocal strain or fatigue, make an appointment with the Grabscheid Voice and Swallowing Center of Mount Sinai by calling 212-241-9410.

Learn more about Speech Language Pathology at Mount Sinai

An Interdisciplinary Approach to Voice Therapy

Updated on Jun 30, 2022 | Ear Nose Throat, Speech Pathology, Your Health

Every patient is different. Unlike many other practices, Mount Sinai Health System laryngologists and speech pathologists work collaboratively to evaluate patients and develop an individualized treatment plan for vocal cord injury.

“Since much of what causes vocal cord injury is behavioral, it is important to include medical, surgical, and rehabilitative perspectives,” explains Sarah Brown, MS, CCC-SLP, a speech-language pathologist at the Grabscheid Voice and Swallowing Center of Mount Sinai.

To assess the condition of your vocal cords, Mount Sinai uses videostroboscopy—a cutting-edge procedure that allows the care team to visualize the vocal cords in great detail. Similar to when your doctor uses a tongue depressor to see the back of your throat, a tiny instrument with a small camera is placed into the mouth. The laryngologist may also use a different technique using a flexible camera through the nose.

Voice Therapy: A Non-Surgical Approach to Care

Most patients benefit from voice therapy before pursuing surgical options. In some cases, voice therapy can eliminate or reduce the extent of surgery needed. Mount Sinai specializes in minimally invasive procedures. These include in-office laser and microlaryngoscopy, which uses high-energy beams of light to remove lesions under local anesthesia in the office.

During one-on-one treatment sessions, speech pathologists teach exercises that balance resonance, improve airflow, and enhance vocal technique. The goal of voice therapy, Ms. Brown explains, is for patients to learn to speak or sing in a new way that protects their vocal cords. The exercises allow patients to feel more confident in their conversational or singing voice.

Mount Sinai Voice Therapy Techniques

Semi-occluded vocal tract exercises (lip trills, straw phonation, cup bubbles), which help manage airflow and resonance by teaching patients how to properly close their vocal folds without over-squeezing them.

Resonant hums/resonant voice therapy, which increases voice comfort by using gentle humming focused on vibrations in the lips and nose rather than the throat.

Flow phonation, which focuses on maintaining vocal balance through airflow using exercises such as saying “whoooooo” and watching a tissue blow in front of you.

Reducing muscular tension, in which patients are guided through laryngeal massage as well as tongue, shoulder, and neck stretches.

Learn more about Speech Language Pathology at Mount Sinai

Prevalence and the Understanding of Autism Spectrum Disorder Are on the Rise

Updated on Nov 12, 2025 | Community, Pediatrics, Seaver Autism Center, Your Health

The Seaver Center for Autism Research and Treatment at the Icahn School of Medicine at Mount Sinai is advancing the understanding of autism spectrum disorder.

Autism spectrum disorder (ASD) is increasing in prevalence, but so are options for evaluation and therapies, said Paige Siper, PhD, Chief Psychologist for the Seaver Autism Center for Research and Treatment, and Michelle Gorenstein, PsyD, Director of Outreach for the Seaver Center. “The interesting and exciting part about the work that we do is that we get to see toddlers through adults, and I think that is something very unique about this field,” said Dr. Siper, Assistant Professor of Psychiatry, Icahn School of Medicine at Mount Sinai. The virtual talk can be viewed here.

Paige Siper, PhD, Chief Psychologist of the Seaver Center

“Autism Spectrum Disorder Across the Lifespan” was part of a series featuring speakers from around the Mount Sinai Health System as well as the community to raise awareness and promote an inclusive and equitable health care environment for people with disabilities.

Dr. Gorenstein, Assistant Professor of Psychiatry, Icahn School of Medicine, said that an important tool in the field is Applied Behavioral Analysis, a class of interventions based on principles of operant learning theory—that is, providing positive reinforcement for observable behavior, like asking for a push on a playground swing, or making a choice. Another therapy, Relationship Development Intervention, is a family-based method that builds social and emotional skills. And there are a variety of therapies to treat conditions that can accompany ASD, such as anxiety, ADHD, or epilepsy.

Michelle Gorenstein, PsyD, Director of Outreach for the Seaver Center

ASD is characterized by difficulty with social communication, as well as the presence of repetitive behaviors or restricted interests. ASD is primarily a genetic disorder but can also be influenced by environmental factors. Dr. Siper said multiple studies have shown that vaccines do not cause ASD, dispelling a common myth.

One in 54 children in the United States are diagnosed with ASD, and boys are four times more likely than girls to receive the diagnosis. ASD can be identified in children as early as age 18 months, which makes early intervention very important in improving social, communication, motor, and daily living skills. “Early intervention can change outcomes,” Dr. Siper said. “It’s the opposite of watch and wait.”

The Seaver Center is dedicated to caring for people of all ages with ASD, furthering research into risk factors and drug development, and leading clinical trials. “One of the unique things about our Center is that it really does translate the basic sciences to the clinic,” Dr. Siper said. For more information, visit the Seaver Center site.

Mount Sinai Researchers Report Significant Secondhand Marijuana Smoke Exposure In New York City Apartments

Updated on Jun 30, 2022 | Featured, Your Health

Mount Sinai researchers have raised concerns about significant exposure to marijuana secondhand smoke in New York City apartments.

Data from a new study suggesting nearly one third of families smell marijuana smoke when their children are present raises concerns about the potential impact of legalized marijuana on vulnerable populations, particularly children, according to the researchers.

The researchers described their findings in a study published recently in Academic Pediatrics. The study looked at secondhand smoke and thirdhand smoke—the particles from secondhand smoke that settle on furniture, carpets, and clothing—in multi-unit households, typically apartment buildings.

The lead author of the study is Lodoe Sangmo, a fourth year medical student at the Icahn School of Medicine at Mount Sinai who will graduate in May with Distinction in Research. Karen Wilson, MD, MPH, the Debra and Leon Black Division Chief of General Pediatrics at Icahn Mount Sinai, is the senior author on the study and an international expert on secondhand and thirdhand smoke exposure—what researchers call “incursions.” Dr. Wilson led an investigation in 2018 that found high levels of marijuana metabolite tetrahydrocannabinol carboxylic acid in the urine of young children whose parents also smoked tobacco. That study was published in Pediatrics.

Karen Wilson, MD, MPH

Researchers say the new study of families living in multi-unit housing in New York City builds on these earlier findings, suggesting that regulators take a close look at the impact on children when considering marijuana legalization.

“As we move towards the legalization of recreational marijuana in New York State, this study serves as a warning that our most vulnerable patient populations who live in multi-use housing will likely experience much higher levels of smoke incursions unless we are intentional about regulating exposure, particularly among children,” says Dr. Wilson, who is also Vice Chair for Clinical and Translational Research for the Jack and Lucy Clark Department of Pediatrics at Icahn Mount Sinai. Dr. Wilson notes that while most states with legal marijuana use restrict its use in public indoor and outdoor spaces, they do not have any restrictions on combustible marijuana use in the presence of children.

For their study, the researchers surveyed parents at four pediatric practices in the Mount Sinai Health System, collecting a total of 382 surveys between September 2018 and December 2019.

Parents were asked, “Do you ever smell marijuana smoke in your room/apartment/ condominium coming from another apartment, when you are with your child?” and “Do you ever smell marijuana smoke in common areas such as the hallway or stairwell, when you are with your child?”

Almost one third (30.6 percent) of participants reported both secondhand and thirdhand smoke, while 47.9 percent had neither incursion, with the remaining 21 percent reporting one or the other incursion.

Participants who identified as non-Hispanic black or Hispanic were more likely to report smelling secondhand smoke than non-Hispanic white participants, a finding that is consistent with disparities in secondhand smoke exposure, caused in part by unequal access and enforcement of comprehensive smoke-free policies within multi-unit housing, according to the researchers.

“In light of these findings, we hope to see the expansion of current policies that solely restrict tobacco smoke to include restrictions on marijuana smoke in order to mitigate disparities and protect vulnerable populations exposed to dual smoke exposure,” says Dr. Wilson.

The study was funded by the Children’s Center Foundation Board of Directors of the Mount Sinai Kravis Children’s Hospital at Icahn Mount Sinai.

According to Dr. Wilson, who chairs the American Academy of Pediatrics Tobacco Consortium, while many states have moved ahead with legalization efforts, research on the effects of secondhand marijuana smoke is still in its infancy.

“We do know that prenatal exposure to marijuana smoke affects brain development and behavior but we don’t know about post-natal impacts, nor about the long-term health effects. We know much more about the detrimental effects of tobacco smoke on children’s health,” says Dr. Wilson. “Studies have linked even low levels of cotinine, a biological marker of secondhand tobacco smoke, with decreased scores on cognitive testing, and asthma. Theoretically, that could suggest that low levels of marijuana could potentially be damaging to the brains and lungs of children.”

Four Tips for Safe Snow Shoveling

Updated on Jun 30, 2022 | Your Health

It’s that time of year again. Snow is starting to fall and fill driveways and sidewalks. Some inspired people will grab their cameras to photograph the beauty, but most will be grabbing their shovels. But how do you shovel snow safely and minimize the likelihood of injuring yourself?

Houman Danesh, MD, Director of Integrative Pain Management at The Mount Sinai Hospital and Assistant Professor of Anesthesiology, at the Icahn School of Medicine at Mount Sinai, provides four shoveling safety tips to help you avoid aches, pains, and strains when digging out this winter.

1. Warm up. Cold muscles are more likely to strain.

2. If you experience pain. Stop. Do not push through it.

3. Take frequent breaks to hydrate every 10-15 minutes. Dehydration increases likelihood of muscle injury.

4. Your shoveling technique is very important. Keep hands at least one foot apart. Use a plastic shovel (lighter than metal) with the proper length (knees slightly bent and 10 degree back flexion with shovel on the ground). Always pivot with your feet when moving snow to the side. Do not twist your back. And, if possible, push the snow, do not lift it.

The American Academy of Orthopaedic Surgeons recommends:

“If you must lift the snow, lift it properly. Squat with your legs apart, knees bent and back straight. Lift with your legs. Do not bend at the waist. Scoop small amounts of snow into the shovel and walk to where you want to dump it. Holding a shovel of snow with your arms outstretched puts too much weight on your spine. Never remove deep snow all at once; do it piecemeal. Shovel and inch or two; then take another inch off. Rest and repeat if necessary.”

And, if you do happen to hurt yourself, contact a Mount Sinai Health System physician for an in-person or video visit.

Make an appointment with Dr. Danesh

Learn more about Pain Management at Mount Sinai

Treating Autoimmune Patients with Airway Disorders

Updated on Jun 30, 2022 | Ear Nose Throat, Your Health

Robert Lebovics, MD, has a famous observation in his practice: “It is amazing what you can see when you just take a look.” As an ear, nose, and throat physician who has specialized in treating autoimmune disorders that impact the airway for more than three decades, he likes to think of himself as the eyes and ears of his patients and other medical specialties—looking at places inside the nose, mouth, and windpipe where they cannot see.

Robert S. Lebovics, MD, FACS, Site Chair of Otolaryngology-Head and Neck Surgery and Co-Director of the Airway Center at Mount Sinai West

Autoimmune disorders occur when the body’s immune system mistakenly attacks healthy tissue and can cause significant damage to the upper airway.

Disorders like Sjogren’s syndrome, Systemic Lupus Erythematosus, and asthma, as well as rare conditions like granulomatosis with polyangiitis (GPA or Wegener’s granulomatosis), eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome), relapsing polychondritis, and sarcoidosis, can cause inflammation to develop within the airway that restricts both blood and air flow. Patients may experience symptoms like coughing, voice changes, facial pain, loss of smell, and difficulty breathing, swallowing, or hearing.

“The airway is ultimately a pipe system,” says Robert Lebovics, MD, Site Chair of Otolaryngology-Head and Neck Surgery and Co-Director of the Airway Center at Mount Sinai West. “If a pipe in your house is blocked it can’t drain or supply water. In the case of autoimmune disease, inflammation forms in the inner lining of these tissues and may cause it to swell, scar, or bleed. The ability of air to move is diminished.”

Typically, patients are diagnosed with an autoimmune disorder by a rheumatologist or immunologist. If the disease is known to affect the airway, they are often referred to an ear, nose, and throat physician. In general, autoimmune diseases are more common in women than men.

Dr. Lebovics uses specialized instruments like a bronchoscope — a thin tube with a camera that is inserted through the mouth and down the throat—to visualize the airway, voice box, windpipe, upper bronchi, and related structures. Even if patients are not experiencing symptoms like difficulty breathing or painful swallowing, it is vital to get a baseline breathing evaluation.

“The best way to deal with a problem is to prevent it,” says Dr. Lebovics. “I do a lot of surveillance. Sometimes patients do not have any damage yet, and other times they come to me and I see they have been breathing through a three millimeter airway that is significantly scarred from Wegener’s or relapsing polychondritis.”

Treatment for Autoimmune and Airway Disorders

Autoimmune and airway diseases are rarely curable and require lifelong monitoring and management. Many of these conditions have a high incidence of relapse and may be life-threatening if left untreated.

Fortunately, there are many therapies that can help. Depending on the severity of disease, patients may need medications like steroids and immunosuppressants, pulmonary rehabilitation, or surgical interventions. Dr. Lebovics works closely with rheumatologists and pulmonologists to develop a personalized treatment plan for every patient. For example, many individuals with granulomatosis with polyangiitis or Wegener’s have associated ear conditions. “These conditions can be multisystem disorders,” says Dr. Lebovics. “It is critical for physicians to work together and create long-term monitoring relationships with their patients.”

COVID-19 Impact on the Airway

Now, more than ever, it is important for anyone experiencing a breathing problem in the nose, mouth, or chest to seek medical attention. If someone becomes infected with COVID-19, it may cause damage to the lungs and lining of the airway. When someone is gasping for air, they often call 911 or visit the closest emergency room. But those who experience slower changes, like finding it progressively harder to climb the stairs or making noises when they breathe, often do not seek treatment fast enough.

“On a simple level, breathing is not underrated, and your physicians need to help you move air,” says Dr. Lebovics. “At Mount Sinai, we have a niche practice that specializes in treating rare disorders of the airway and autoimmune system, and a track record of success in partnering with patients living with chronic disease to improve their quality of life.”