MOST of us take our ability to speak – or sing – for granted.
It’s only when something goes wrong and we are temporarily ‘struck dumb’ that we begin to realise the importance of fully functioning vocal chords.
As Mr Graham Smelt, ear, nose and throat consultant at Huddersfield Royal Infirmary and Calderdale Royal, says: "Your voice is a very important part of your persona. People can lose their voice for all sorts of reasons and will find that they really struggle. It affects their social life and their hobbies, as well as work."
In fact, Mr Smelt and his colleagues speech therapist Gill Jolly and singing teacher Llyndall Trotman – who run a monthly voice clinic, have seen patients who have lost their jobs after losing their voices.
Gill works with everyone from professional voice users such as teachers, vicars, barristers, call centre workers, sales people and actors to members of the public who have simply found that their voice has been affected by old age or illness. Singers, both professional and amateur, are offered further help from Llyndall, a volunteer at the clinic since 2001.
While most major NHS Trusts now have voice clinics, ours is one of the few to have the services of a singing teacher. And it was through another local singing teacher, Sally French, that the clinic came into being in 1996.
But the story goes back even further, to 1989 when Mr Smelt referred a four-year-old boy with a blocked airway for laser surgery in Bradford. His family subsequently launched an appeal to buy a laser for Huddersfield.
Several years later the same patient, whose voice had been affected by the surgery, was taken for singing lessons with Sally.
"She became interested in working with patients," said Mr Smelt, "and that’s when we started the voice clinic."
The reasons why someone loses their voice can range from physical problems such as nodules on the vocal chords to a single incident of ‘voice abuse’, such as shouting at a football match or a parent shouting at their children to warn them of danger.
Those most at risk are people with jobs where they have to raise their voices on a daily basis, perhaps competing against background noise, such as swimming teachers, call centre workers and fitness instructors.
But, perhaps surprisingly, by far the most common cause of voice loss is emotional stress.
"It’s no accident," says Mr Smelt, "that we say things like ‘it brought a lump to my throat’ or ‘I was speechless.’ What happens is that the little muscles in the throat seize up when we are emotional."
Occasionally, patients come to the clinic fearing they have got cancer because they can ‘feel’ a lump in their throats. More often than not this is simply a globus pharyngeus (it used to be known as a globus hystericus because of its connection with an emotional response). One of the causes is thought to be tension in the throat muscles and voice box.
Everyone referred to the voice clinic is given a clinical examination to rule out physical causes of speech difficulties such as lumps or nodules, even asthma.
Then, if no obvious cause is found, Gill and Llyndall step in with exercises and relaxation techniques.
"They can talk about their emotional difficulties and that sometimes helps," says Gill, "and we show them how to improve their technique so they are not straining their voices.
"They may be people who feel they have no voice emotionally OR physically."
Llyndall, who runs her own school of singing in Sowerby Bridge, says she finds patients sometimes respond by opening up.
She said: "When you take someone along the path as a singer their vulnerability unleashes and they may cry and off-load. If people want to see me I’m there for them."
Around five or six patients are seen at each clinic, held at Calderdale Royal Infirmary. Anyone with a voice problem can ask their GP for a referral.
"There needs to be more public awareness of people with communication problems," says Gill, who is a member of The Royal College of Speech and Language Therapists, which is currently running a year of promoting the profession using the slogan "Giving Voice".
GILL Phillips works in the front line of customer service and spends much of her day talking on the telephone and in person.
She is also an enthusiastic choral singer.
Last spring she suffered from a cold and laryngitis that left her voice sounding croaky and gruff.
“People who know me could tell it wasn’t right and after several weeks it was no better,” she explained.
“With something like laryngitis your voice normally comes back after a few days but, stupidly, I carried on working and didn’t give it a rest.”
Gill, 45, from Kirkburton, is a long-serving member of the Denby Dale Choir and was worried that the condition was affecting her ability to sing.
“I’ve been with the choir for 21 years and sing second soprano. I absolutely love it. Singing is so uplifting, it takes away the stress of the day,” she said.
There was no physical cause for Gill’s continued discomfort so she was referred for speech therapy.
“I was taught how to relax and open up the back of my throat. As a singer I found it very useful and I now know how to protect my voice,” added Gill, who works for Huddersfield company Fired Up.
“I had about eight sessions and still use the exercises from time to time because occasionally the croakiness does come back.
“I think I did have a quite a bit of stress and I’m almost certain I would still have the problem now if I hadn’t had speech therapy,” she said.