Does Vaping Hurt the Voice?

Although research is not yet conclusive regarding vaping and the effect on the voice, there is proof about the vocal effects of traditional cigarette smoking. Smoking and vaping are similar in many ways, which suggests that they may also cause vocal injury in a comparable fashion

By Sarp Kurtoglu and Dr. Reena Gupta*

What is vaping?

Vaping is the use of an electronic device to heat the contents of an inhaler cartridge and produce a vapor, which the user inhales. The cartridge may contain vegetable glycerin, polyethylene glycol, flavoring, nicotine, or other substances. The cartridge is put inside an e-cigarette and a sensor in the e-cigarette is triggered to heat this liquid quickly, producing a vapor that the user inhales.

What is e-juice?

Vaping cartridges contain a liquid, commonly called e-juice. This is not a standard formulation and can contain varied chemicals. Most commonly, e-juice contains nicotine, vegetable glycerin, and propylene glycol. Additional substances may be added for flavoring.

Are the chemicals in vape cartridges dangerous?

While some of the chemicals in e-juices have been studied, the vaporized form often has not been evaluated and may potentially be more harmful that other forms of consumption. Some, such as nicotine and the flavor-producing chemicals, can be toxic or carcinogenic.

Both cigarettes and e-liquids typically contain nicotine, which is known to be addictive. E-juice actually contains higher amounts of nicotine than cigarettes. Unlike cigarettes, and more concerning, is that vape users can purchase extra-strength cartridges with higher concentrations of nicotine. A single vape cartridge may contain the same amount of nicotine as 20 cigarettes.

How can smoking and vaping affect the larynx and vocal cords? 

The vocal folds are very delicate structures responsible for breathing and sound production. They are located in the throat, and serve as the “entrance” to the lungs. The smoke or vapor that is inhaled from smoking and vaping passes the vocal cords.

Research has shown the negative effects of cigarette smoking on the vocal cords. Several studies also suggest that electronic nicotine delivery systems cause tissue changes in rats, including pre-cancerous changes.1 This suggests that the same would occur in human tissue.

Another experiment assessed the toxicity of vegetable glycerin, which is known to be harmless in liquid form. The effects change in aerosol form. The experiment concluded that the aersolized form lead to to cell changes within the larynx, specifically the lining of the epiglottis.2 The types of changes seen are known to be pre-cancerous. The assumption is that the same effect would be seen with vaping.

If the delicate lining of the vocal cords are exposed to hot, vaporized chemicals, the tissues are likely to undergo change and lose their ability to behave normally.3 This may produce hoarseness, loss of vocal range, voice fatigue, or vocal injury.

How can these disorders affect one’s voice?

Vocal cords make sound by vibrating, and producing a symmetric and smooth vibration. The lining of the vocal folds is partly responsible for the quality of the vibration. However, the lining can be affected by irritants in the air. Vaping produces a throat-irritating vapor that is inhaled past the vocal cords, resulting in swelling of the vocal cord lining and tissue. When the lining is irritated in this manner, it is more fragile and easy to injury. It is also more difficult to work with, which causes the singer or actor to push harder for sound production.

The combination of swelling of the vocal cords and pushing the voice make injury more likely. Injury may take the form of vocal fold nodules, polyps, or cysts. Reinke’s edema, which is chronic swelling and changes to the vocal fold tissue that is seen in smokers, may also occur. Swelling of the vocal folds will affect the singer’s vocal range.4 Finally, vaping results in significant compromise of the lungs, which are the power source for the voice.5 Poor ventilation and inability to generate a strong breath results in a more pushed sound, with throat muscle use rather than breath support. The coughing associated with lung irritation will also cause vocal cord swelling and higher risk of injury.

For those who use their voices for  a living, there are major risks associated with vaping, that may cause irreversible vocal damage. This should be strongly considered before taking up the habit.

References:

  1. Salturk, Ziya. “Effects of Electronic Nicotine Delivery System on Larynx: Experimental Study.” Journal of Voice, 2015, www.jvoice.org/article/S0892-1997(14)00243-4/fulltext.
  2. Renne, R A. “2-Week and 13-Week Inhalation Studies of Aerosolized Glycerol in Rats.” Taylor & Francis, 2008, www.tandfonline.com/doi/abs/10.3109/08958379209145307?journalCode=iiht20.
  3. Renne, Roger A., and Katherine M. Gideon. “Types and Patterns of Response in the Larynx Following Inhalation – Roger A. Renne, Katherine M. Gideon, 2006.” SAGE Journals, 2006, journals.sagepub.com/doi/full/10.1080/01926230600695631.
  4. Gonzalez, Julio. “Early Effects of Smoking on the Voice: A Multidimensional Study.” Medical Science Monitor, 2004, www.medscimonit.com/download/index/idArt/13230.
  5. Christiani, D.C., et al. “Imaging of Vaping-Associated Lung Disease: NEJM.” The New England Journal of Medicine, 6 Sept. 2019, www.nejm.org/doi/full/10.1056/NEJMc1911995.

*About Sarp Kurtoglu. Sarp Kurtoglu is a senior attending Beverly Hills High School in Los Angeles, California. Sarp is involved in his school’s Model United Nations, Medical Science Academy, and tennis clubs. He also volunteers at the Ronald Reagan Hospital.