Phonatory gap (adults)

About a phonatory gap

A phonatory gap means your voice muscles do not close completely when you talk, and this lets air escape. It can affect the sound or feeling of your voice, making it breathy, hoarse and/or weak.

If you have a phonatory gap, your voice is likely to feel tired if you talk for a long time.

Causes

There are different causes of a phonatory gap, so it is important that you have an examination in the Ear, Nose and Throat (ENT) department. This will help us make the correct diagnosis, understand why it is happening, and decide on the best treatment for you.

Possible causes include the following.

• Muscle tension. This means the muscles in and around your voice box may be out of balance and unable to move easily.
• Silent reflux (also called laryngopharyngeal reflux or LPR). This means your stomach contents come up and into the back of the throat. This can cause swelling, redness and/or irritation to your throat, and affect how your voice muscles move.
• Nodules (lumps of body tissue) or swellings on your voice muscles.
• After surgery. If you have been given a breathing tube during surgery, this can keep your voice muscles apart for longer and make the gap wider than usual. This can cause soreness, and change how your voice muscles move.
• Under- or over-use of your voice. This can affect how well your voice muscles move. For example:
  • if you talk a lot, with loud noises in the background. This is especially true if you do not have good vocal technique.
  • if you do not use your voice for a long period of time.

Symptoms

Symptoms are different from person to person but they may include:

• hoarse voice
• breathy voice
• continuing feeling of needing to clear your throat
• loss of voice (on-and-off, or complete loss)
• vocal strain or tiredness
• difficulties when trying to talk more loudly.

Treatment

The treatment we recommend will depend on the cause of your phonatory gap. It will also depend on how long you have experienced it.

Possible treatment includes the following.

• Therapy exercises. These help your voice muscles to close completely and develop vocal strength. A speech and language therapist (SLT) can advise you on the best exercises for you, depending on what has caused your phonatory gap.
• Reflux management. (Reflux means your stomach acid or stomach contents come up into your throat). We may offer you medication to help stop your digestive juices flowing into your throat and reaching your voice box. We will check with your GP if we offer you medication.
• Breathing help. You may need help from a respiratory doctor. They can check for any underlying breathing issues, such as asthma, and suggest the right medication for you.
• Relaxation techniques. These can include deep breathing exercises and stretches for your neck and shoulders.

Useful tips

The following tips can help protect your voice.

• Stay hydrated (drink enough). Aim to drink 6 to 8 glasses of water every day. This will help your voice muscles move more easily.
• Avoid eating and drinking the following (they can dry out your throat):
  • medicated lozenges (menthol sweets)
  • caffeine (tea, coffee and caffeinated drinks such as Red Bull)
  • alcohol.
• Breathe-in steam regularly (for example the steam from a hot drink).
• Try not to shout.
• Make sure your home is well ventilated and humidified (has moisture in the air). House plants and shop-bought humidifiers can help to humidify your home.
• Make time, every day, for rest and relaxation. This will help you manage stress.
• If possible, wear a mask when you are in dusty environments.
• If you use a steroid inhaler (for asthma), make sure you take sips of water after using it. This will help to rinse your throat.
• You may benefit from being referred to an SLT who specialises in treating voice and throat problems. They may suggest throat relaxation or other techniques.