Vocal Health

Butt Out! Medical Reasons Why Voice Actors Should Quit Smoking

If you’ve ever smoked, do smoke or have quit, you know what cigarette smoking can do to your voice.

I had the privilege of attending and covering the Midwest Voice Conference and also the great pleasure of meeting and recently interviewing Dr. H. Steven Sims, a board certified Otolaryngologist and graduate of the Yale University School of Medicine. This interview poses questions about voice care and how cigarette smoking affects the voice.

Dr. Sims’ personal experiences and education are employed to address the problems of performing artists and other voice professionals at The Chicago Institute for Voice Care, and is dedicated to increasing the awareness of the unique issues faced by performing artists and providing comprehensive care.

VOX: How does the speaking voice change when a person has been smoking for a period of time?

Dr. H. Steven Sims: I would be indulging in shameless hyperbole if I suggested that every person who ever smoked ruined their voice. Sarah Vaughan is still revered and envied because she did little to protect her voice, but was still able to sing.

That said, the vocal clarity of her youth went away and never really came back (Aretha Franklin had the same result). Typically, smoking creates chronic swelling (edema) on the vocal fold and not only does the voice become less clear, it becomes harder to vibrate the vocal folds and higher frequencies, so the pitch becomes lower as well. Even one cigarette slows down the movement of mucus across the vocal folds and makes a person more likely to have trouble with phlegm for a few days (not just the time while someone is smoking, but afterwards).

VOX: Does it “feel” any different when smokers talk? If so, what feels different, and do they need to compensate for anything to achieve a desired performance?

DR. SIMS: From what patients tell me, it typically feels like it takes more effort and they need to clear their throats more often. I don’t think it necessarily hurts to talk or anything like that, but the reality is that cancer risk goes up so that if a smoker does begin feeling pain, the suspicion of cancer, and need to rule it out, are more acute than in a non-smoker. Also, many people feel a chronic “tickle” in the thoat.

VOX: What kind of challenges (due to cigarette smoking) are present in a voice over / singing career that are not present for non-smokers?
DR. SIMS: Back to my first answer. The vocal folds are more likely to be changed structurally. So, range will often be decreased, endurance will often be shortened, and clarity will often be eroded. Also, the chronically irritated throat is harder to work with. It’s harder to do voice-over work with a chronic tickle. It’s like playing with an instrument that is out of tune and needs to be constantly tuned during rehearsals and performances.

VOX: Have you ever had to scope vocal folds to assess damage for a voice performer that has needed to be repaired through rehabilitation or surgery? I’ve observed this procedure and am interested to know if this is a common procedure for voice artists who smoke or suspect nodes.

DR. SIMS: Sorry to refer to myself, but I’m going back to the second answer on this one. I think it is important for any person who relies on the integrity of their voice for livelihood to be scoped if there is vocal trouble. However, for the voice-over artists who smokes, it’s more critical to rule out cancer. So, I have absolutely seen professionals who have experienced voice changes. Some have been diagnosed with cancer and some have had benign changes from smoking. I use laser surgery as well as delicate instruments under the microscope to repair damage as well as to remove cancers.

VOX: Could you please describe nodes for us? How do people get them and how would they know if they have them?

DR. SIMS: In crude terms, nodes or vocal nodules are like callouses. They are the product of repetitive injury and the vocal mucosa responds by thickening. As such, people get them by overusing/misusing/abusing their voices. Teachers and pastors are highly vulnerable. Typically, the first sign is a change in the quality or purity of the voice and loss of higher notes/upper register.

VOX: What can smokers do once they’ve quit to implement a voice recovery plan / schedule? To give us some perspective, please detail what a usual day be like for someone post-operation during recovery for vocal surgery.

DR. SIMS: These are actually very different. After vocal fold surgery (phonosurgery) patient are on strict voice rest for a week. This means no talking, no singing, no whispering, no sound, basically. After someone quits smoking, the physical changes to the vocal folds can take months to resolve. In both cases, however, I do recommend working with a speech pathologist to help the patient adjust to the changing structure of the vocal folds.

VOX: Are there any special warmups or rehabilitation practices for the voice, breathing, and or vocal mechanisms that you recommend?

DR. SIMS: This actually ties back into my sixth answer, there is a very long list of exercises and the discipline of speech pathology-voice rehab focuses on this. I can ask my speech pathologist what she uses most often, but I think they tailor each program to the individual. Basic things like breathing and word conservation (not rambling on and on until you run out of breath during a sentence) is always helpful.

VOX: How important is it that a former smoker’s family takes an active, supportive role in their recovery?

DR. SIMS: Quitting smoking (like breaking any bad habit) is VERY difficult to do alone. The support of family and friends is essential. Ecclesiates 4:9-10 is really critical here. When we fall down, we need someone to help us get back up and two (or more) are really better than one when you go into battle!

VOX: In your opinion, what is the demand for the “smoker voice” or “whiskey voice” in today’s society and in the commercial advertising world? Was it once in demand and the era has passed?

DR. SIMS: I think there is still a mythical belief that the husky voice is sexy. However, we’ve realized the outcome now. Jack Klugman’s voice isn’t so sexy now. In general, we are more aware of the extremely deleterious effects of smoking and this trumps the idea that a smoker’s voice is sexy. Also, the demand has decreased as society’s desire to support bad habits like smoking has decreased.

VOX: Can you give any examples of people who have quit smoking to save their careers? How did they quit, manage get through the first stages of being a non-smoker, and be smoke-free to this day?

DR. SIMS: I can’t really give the example per se, but Barack Obama is easily the most recognized person struggling with kicking this habit. It is unclear if he’s really “quit” but, he’s trying because it just plain looks bad for the leader of the free world to be an open smoker. I think quitting is just so individual. I have patients who just decided they didn’t want to do it anymore, quit and have bee smoke-free for decades now.

Others constantly struggle and are vulnerable to relapses at really anytime. There’s also the correlation between mental illness, addictive personality traits and cigarette smoking, so for some people the struggle is even greater. Mostly now, I think jazz and blues people are the ones who think a smokey voice is a good one.

VOX: Are there distinct differences between how people may have sounded as a smoker in the past as compared to how they would sound as dedicated non-smokers in their present? I’d like to use Don LaFontaine as an example here. He smoked earlier in his career and up until his death, had been smoke-free for nearly 20 years. He’s one the most recognizable voice actors of all time and he quit smoking.

As a voice doctor, how would you describe the difference in vocal quality, performance and or ability in a person such as Don LaFontaine who chose to stop smoking and enjoyed 20+ smoke-free years? Would his voice have changed at all?

DR. SIMS: This one’s hard because we’re comparing reality to speculation. It’s possible that his voice wouldn’t have deteriorated, but if one looks at Bette Davis, you can see how frail she appeared and how unpleasant her voice sounded in interviews she gave near the time of her death. I do think he’s a good example of how clear the voice can become after a smoking history if the patients quits. Also, lung capacity is improved which improves endurance and the risk of heart disease is reduced which also just makes the person more likely to be able to perform longer.

VOX: What is the best thing a former smoker can do once they’ve quit to take charge of their voice in a healthy manner?
DR. SIMS: The best thing is quitting. However, it’s great to look at diet and exercise to help undo the effects of a bad habit. Vitamins A, C, and E do help with reversing cancer risks. Also vegetable that have color, yellow, orange, green, and red tend to carry nutrients that one’s body would love to have after being exposed to smoke (or, in general for that matter). Drinking plenty of water is always good and 20 minutes daily exercise helps condition one’s body. I really tend to think of professional voice users and vocal athletes and approach health as an overall level of fitness.

VOX: Should people insure their voices? If so, how important to do you think it is for a voice actor or singer to insure their voice, and do you know of any cases where the insurance has actually come in handy?

DR. SIMS: I think the concept of insuring a body part is the product of a creative publicist. To explain, I think a performing artist who gets disability insurance is wise. I have disability insurance because if lost the use of my surgical skills, I’d still need to live, but one could state that I insured my hands. It’s not accurate, but also not untrue. I think that’s what many people are talking about when they say they “insured” their voice. That said, I do think disability insurance is a good idea IF loss of voice would mean TOTAL loss of income. It’s important for people to remember that if you insure your voice, you have to pay a premium for that.

VOX: If someone would like to contact you, how would you prefer they do that?
DR. SIMS: www.ChicagoVoiceDoc.com or [email protected] . They can also call 312-996-6555.

Any Comments?

Looking forward to hearing your thoughts!
Best wishes,

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  • Avatar for Ran Alan Ricard
    Ran Alan Ricard
    January 9, 2009, 9:39 am

    WOW … great article. Thanks

  • Avatar for Corson Bremer
    Corson Bremer
    January 9, 2009, 11:18 am

    An interview that was very disappointing. Clearly Stephanie was following a personal agenda concerning the subject… an amateur and ignoble technique. The guest is supposed to provide information, not confirm the interviewer’s opinions.
    Consequently, very few facts were presented. Dr. Sims, as any qualified professional would have done, just referred Stephanie’s poorly-prepared questions to other medical specialists, which should have been obvious in advance.
    And why would Dr. Sims have any knowledge of Don LaFontaine’s situation? A voice professional who smoked for almost 30 years before quitting clearly did irreversible damage to his respiratory tract, but did it work against him professionally? Probably not. Whether you agree or not, his voice established the benchmark for voice professionals for at least 40 years and still does. Dr. Sims says that smoking lowers he pitch of the voice. There are lots of actors who feel they need that for the marketplace.
    Contrary to Dr. Sims opinion, I feel that the belief that the husky voice is sexy is not mythical. He says, “However, we’ve realized the outcome now.” Wrong again, Doctor. The demand for the husky, “smoker voice” or “whiskey voice” in the commercial advertising world hasn’t changed. (Look at George Clooney and don’t forget, Don LaFontaine was never out of work in the last 10 years and he was always number 1 of those in demand.) We don’t find voices like Adam Sandler’s or David Krumholtz’s doing trailers or promos.
    Let’s try to keep the realities of the marketplace in mind and not just campaign against smoking for the sake of campaigning against smoking. True, smoking is, generally speaking, risky and not a good thing. But, apart from the sheer pleasure some smokers have with tobacco (for which there is no argument that will change them), smoking has always been a way for males to lower their speaking voices should they feel they need to. (… and so has whiskey! 🙂 )
    The essential here is to remember not so much the state of your vocal cords but rather that your respiratory capabilities are in jeopardy if you smoke. Doubling your breaths-per-minute in a 30-second spot (or worse, wheezing) will kill your casting opportunities. It’s your breathing that counts; Your voice will take care of itself (in marketing terms). And, hey, if you don’t have an income, how can you pay for possible (but unlikely) cancer treatments?

  • Avatar for Stephanie Ciccarelli
    Stephanie Ciccarelli
    January 9, 2009, 11:26 am

    Hi Corson,
    Thank you for sharing your thoughts.
    Now, if I could, I’d like to share why I asked the questions of Dr. Sims that I did.
    These questions were actually asked of Don LaFontaine but he died just days before he could answer them. He wanted to talk to me on the phone but I thought it was best to wait until he felt better. Within less than two weeks of receiving the questions, he was hospitalized for the last time.
    I had been waiting to ask someone these questions meant for Don, albeit slightly rephrased, and I feel that Dr. Sims, who cares deeply about this subject and was not simply humouring me with his responses, was very sensitive to the issue and presents information that is valuable to those who wish to make use of his answers. Don deeply regretted smoking and was one of the most adamant advocates for leading a smoke-free life.
    Having met Steve, and also having known Don, I believe that the answers provided have honoured what Don might have shared if he could have done so.
    Kind regards,

  • Avatar for Kara Edwards
    Kara Edwards
    January 9, 2009, 12:25 pm

    You did a wonderful job with this interview- thank you passing along some very important information! 13 years ago I sat in the control room of a radio station as a lowly intern. The PD of another station took it upon himself to inform me that I had no shot in the business with my voice. His suggestion was to take up smoking.
    Thankfully, I decided not to listen to him, and enjoyed 11 years in radio both on a national station and several highly-rated morning shows. I’m also thankful I never started smoking because I would not have the voice over career that I have today. No, I don’t voice movie trailers and likely never will with my high-pitched voice. My time is spent voicing animations, eLearning, promos, audiobooks, and commercials instead.
    There is a place for every type of voice in this business- embrace who you are and ignore anyone who would suggest that smoking might help your career.
    Thanks again Stephanie!
    Kara Edwards

  • Avatar for Tammy Ryan
    Tammy Ryan
    January 9, 2009, 12:54 pm

    Hi Stephanie,
    The only problem I have with anything that Dr. Sims had to say was referring to cigarette smoking in the context of “bad habits”. 🙂
    It’s an extremely powerful addiction that consumes a smoker physically, socially, and mentally. It’s a physical impulse that is conquered hour by hour every day. Can you tell I just quit after 25 years as a smoker? It is by far the hardest thing I’ve ever done. I am very grateful for this article. One of the strongest influences in my decision to quit besides the obvious; health, vanity, cost, was the fact that I was going back to using my voice to earn an income. Another turning point solidfying my decision was a friend off-handedly pointing out to me that my voice seemed lower. As a lifelong performer I didn’t need a doctor or pathologist to tell me that smoking had altered my voice. As a singer I went from a Soprano 1, to an Alto. I have been very concerned about what permanent damage I may have done to my voice in those 25 years. I feel much better after reading this article that if I keep doing what I’m doing; stay smoke-free, diet, and exercise, I can improve my voice and maintain my vocal health.
    A big thanks to both you and Dr. Sims.

  • Avatar for Kim White
    Kim White
    January 9, 2009, 1:11 pm

    Thanks for posting this. This is so important, because no one should place career over health. Period. We’ll never know whether Don would have been “The Movie Trailer Guy” without cigarettes… Don’s talent was even greater than his voice.
    My coach has a saying: “Just what IF that thing that makes you uniquely you is the thing that would make you successful?” Why change it by smoking, drinking, etc. and possibly miss the opportunity to succeed… AND stay healthy?

  • Avatar for Nancy Wolfson
    Nancy Wolfson
    January 9, 2009, 1:22 pm

    Tammy, I am so proud of you. I can only begin to imagine the courage and enormous personal strength you summoned to achieve this, not just for yourself but for those who love you. As for you, Stephanie, well, “amateur” and “ignoble” are words that are ridiculously far from suitable descriptors of anything you have ever said or done. In acting and in life, so much comes down a person’s intention. Yours, to me at least, always reads as coming from a place of wanting to help others. Thank you.

  • Avatar for Dr. Sims
    Dr. Sims
    January 11, 2009, 2:57 pm

    Hello Stephanie,
    I am delighted that this interview encouraged lively discussion.
    In response to Corson and really anyone else who has curiosity about this. There are volumes of documented evidence that smoking not only effects breathing capacity, but also effects the squamous mucosa of the vocal folds as well as the lamina propria that lies beneath the vocal fold mucosa.
    It’s also proven and accepted that the effects of smoking are not “clearly irreversible.” I am particularly concerned about this comment because it suggests that smoking cessation offers no benefit (if the damage can’t be reversed.) Quite on the contrary, the human body is more dynamic that static and cells can respond to the withdrawal of an offending agent and can heal.
    I wish to be exceptionally clear that I agree with Corson that my responses include my personal opinion and I would never have my thought masquerade as immutable fact. However, the fact that smoking poses a direct risk of cancer to the larynx as well as the lungs is absolutely a clinical reality, not my opinion and even a cursory review of google would support the assertion in the interview that smoking is not just about bad effects on breathing. Also, I respect the right of any adult to make a choice regarding her/his health and weigh that choice against her/his career concerns. I grew up in West Virginia and I know plenty of people who choose to accept the risks of working in the mines because the compensation is considerable. Despite the fact that I understand WHY someone would make that choice, I would be remiss if I neglected to admit that mining is risky and dangerous simply because I have sympathy for the fact that miners need the money.
    I would also ask for Tammy’s forgiveness if I gave the impression that smoking was just a bad habit. I did not go into an explanation of how nicotine effects the brain other parts of the central nervous system. My comment was meant to underscore the fact that it is difficult to stop smoking as it is difficult to break bad habits. In both cases, there is something (whether psychological, physical, or both) that compels one towards behavior they would rather change.
    I hope this clarifies.

  • Avatar for Tammy Ryan
    Tammy Ryan
    January 16, 2009, 12:06 pm

    Your apology is totally unwarranted Dr. Sims, I’m an agitator by nature 😉 Your insights were invaluable. I only mentioned it because I’ve had two different medical professionals tell me in the past six months to “just quit”. These words can only be spoken by someone who has clearly never smoked before. It isn’t a moral failure, but a clinical addiction and psychological dependency that I miss every minute of every day. In my previous email I decided not to include my opinion that if you believe that smoking doesn’t affect your vocal cords you’re either delusional or ignorant. I refrained from saying that before because I didn’t want to appear arrogant or condescending. Ooops, I guess I just said it. 🙂 Regardless, I appreciate your follow up and informed medical opinion on the subject. No apology necessary and thanks again for your contribution on the subject.

  • Avatar for Jenna
    May 3, 2013, 1:36 pm

    I am 28 yrs young and have been smoking for 10 years. I am a singer and have been singing since I was very little. I used to be able to mimic Mariah Carey whenever I wanted, plus belt out long and hard notes on command, and now I get lots of compliments on the color of my voice, but I am deeply saddened by the depletion in my range. I basically no longer have any falsetto left at all, and when I try to use a higher pitch…it just squeaks and sounds vacant…. plus now I can only sing 4 songs in a row before my voice just starts sounding beady and beyond scratchy. 8( I am not sure if I have polyps from vocal abuse, or just smokers voice???? I am uninsured sadly and just to get checked for polyps cost $650 here in Ohio. I hope and pray after reading this I will quit sm for good and regain some of my vocal awesomeness I used to own. I get so jealous when I cant do what I once could, but someone who has no vocal control can hit higher notes and get more attention. GRRR I am gonna stop smoking today 3-04-2013 ..I will check in with any progress!! please feel free to respond in any way helpful.