The first days and weeks immediately following surgery are the critical period for vocal cord recovery. Proper care allows your vocal cords to heal rapidly, and decreases the risk for further injury to your vocal cords.

It is very challenging not to talk or otherwise use your voice, but following these recommendations will help your vocal cords heal faster, and will give you the best result from your surgery.

While you are recovering, be sure to drink lots of water (at least 64 ounces per day). This helps to promote healing of the vocal cords.

Importance of Total Voice Rest

While your vocal cords are healing, they must not come into contact with each other. If they come into contact with each other, they may heal more slowly or may be injured.

This means no talking. Do not whisper.

Implementing Total Voice Rest

Total voice rest means not using your voice at all (complete silence). During this time, it is very important for you to do no talking, mouthing words, whispering, or any of the other activities listed below.

All of these activities cause the vocal cords to come into contact with each other, which can slow down or interfere with your vocal fold healing or lead to further injury.

For the length of time prescribed by your otolaryngologist and speech therapist, you must not do any of the following:

• Talking
• Whispering
• Whistling
• Humming
• Singing
• Laughing
• Coughing
• Crying
• Throat-clearing
• Groaning
• Holding your breath
• Yelling
• Lifting heavy objects

Communication with Total Voice Rest

You will need to have another way to communicate besides speaking. You can use:

• Pen and paper
• Small dry-erase board
• E-mail
• Gesture, pointing, charades

Other things to avoid during your recovery:

• Smoking or second-hand smoke
• Strong chemicals (from cleaners, perfumes, etc.)
• Alcohol
• Caffeine
• Catching a cold: Wash your hands often, avoid touching your eyes, nose and mouth, and avoid being around people who are sick.
• Aspirin and ibuprofen (acetaminophen is fine)
• Running, swimming, aerobics, heavy lifting, or strenuous exercise (weight lifting)

Starting to Talk Again

Ideally, you should begin talking again only with the guidance of your speech therapist.

After you have completed voice rest, you will begin talking by using a quiet voice. You will start by talking for a very short amount of time each day, and then talk for a little longer each day.

These amounts of time are not meant to be done all at once. This should be your total talking time spread out over the entire day. For example:
Day One: 10 minutes (Five minutes in the a.m. / five minutes in the p.m.)
Day Two: 20 minutes (10 minutes in the a.m. / 10 minutes in the p.m.)
Day Three: 40 minutes (20 minutes in the a.m. / 20 minutes in the p.m.)
Day Four: 1 ½ hours (45 minutes in the a.m. / 45 minutes in the p.m.)
Day Five: Three hours
Day Six: Six hours or a normal amount of voice use

As you begin using your voice again, it is very important that you:

• Don’t try to talk over noise (radio, television, in noisy restaurants, etc.)
• Don’t use a loud voice
• Don’t whisper
• Don’t yell
• Don’t sing
• No phone use for first week
• No singing until fourth week

Confidential Voice

During the first two weeks of using your voice again, use a "confidential voice." This is the kind of voice you would use to talk to someone who is standing very close to you, when you are telling a secret, or when you are talking in a library and trying not to disturb other people. This is not a whisper.

The purpose of this voice is to allow the vocal cords to come together very, very gently so that they will continue to heal.

Tips to remember:

• Use a soft, breathy voice
• Don’t try to be loud
• You will need to take more breaths as you talk
• Do not whisper

After these two weeks of using confidential voice, you may return to using normal loudness. You should still not do any yelling, singing, or talking over noise until cleared by your speech therapist.

At any stage during your recovery, rely on how your voice feels as a guide for continuing or stopping an activity. Don’t try to make your voice sound perfect right away.

Your voice will likely be hoarse to some degree during the first few weeks after surgery. Make sure that your throat feels easy (not strained or tired). If your voice feels tired, rest it.

Contact your otolaryngologist (ENT doctor) if you voice suddenly gets worse anytime during recovery.

This article is intended as a resource for patients receiving their voice care at Duke Voice Care Center. It is not intended to substitute for medical advice from your health care team. If your doctor’s instructions differ from the information in this article, please talk with your doctor before making any changes.