Bogart-Bacall Syndrome: a Guide to Avoiding Vocal Fatigue

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Photo Source: “The Big Sleep” Courtesy Warner Bros.

Humphrey Bogart and Lauren Bacall are two defining figures of Hollywood’s Golden Age whose famous on- and offscreen partnership and distinct voices are an integral part of film history. Their careers included numerous awards and titles. However, their names are also synonymous with a condition caused by the overuse of vocal cords—a situation every voiceover actor should avoid at all costs. 

Keep reading for information about what causes Bogart-Bacall Syndrome, its symptoms, and how to prevent it from happening to you.


What is Bogart-Bacall Syndrome?

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Bogart-Bacall Syndrome—or clinical vocal fatigue syndrome—is caused by the overuse or abuse of the larynx or voice box (the vocal cords vibrate within the larynx) through speaking or singing for long periods of time. Often, a lower register can lead to the syndrome. 

Muscle Tension Dysphonia (MTD) is the official medical condition that accompanies the syndrome, and there are two types. (Dysphonia describes “an abnormal-sounding voice.”) Primary MTD is caused when “the muscles in your neck are tense when you use your voice, but there is no abnormality in the larynx.” Bogart-Bacall Syndrome is what’s known as secondary MTD, which is an “abnormality in the voice box that causes you to over-use other muscles to help produce your voice.” 

Bogart-Bacall Syndrome can affect anyone who overuses their vocal cords in a professional capacity. Speaking or singing in a lower register than you are used to can strain or overexert the vocal muscles, causing hoarseness and other long-term effects. 

If you use a lower pitch range, it is still possible to talk when your lungs have expelled almost all of their air. The effort to do so, however, puts a strain on the muscles used for respiration and speech. This strain can change the position of the larynx and vocal cords and cause vocal fatigue or vocal cord overuse symptoms.

Why Is It Called Bogart-Bacall Syndrome?

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Bogart and Bacall are not only two of the most influential names in noir cinema, they were also one of Tinseltown’s most famous real-life couples. Sparks began to fly between the actors when director Howard Hawks cast the pair in “To Have and Have Not” in 1944, when Bacall was 19 and Bogart was 25 years her senior (and married). After Bogart divorced his first wife in 1945, the couple tied the knot in a fairy-tale ceremony. The power couple cemented their status with “The Big Sleep” (1946), “Dark Passage” (1947), and “Key Largo” (1948). It was a union cut short when Bogart died from cancer in 1957, but their romantic legacy remains. Bacall’s husky voice remained a signature throughout a long career until her death in 2014. 

A study published in 1988 found that 67 adult professional voice users in vocal treatment over a five-year period shared similarities to the vocal pitch of the two movie stars. This wasn’t because they were trying to do an impression of the couple, but, rather, because they had “a musculoskeletal tension disorder involving the larynx and supporting structures [that was leading] to vocal dysfunction.” 

Bacall’s deep register and husky tone is so famous that her obituary in The Los Angeles Times begins, “The voice. If you heard it once, you never forgot. So distinctive was its smoky, sexual growl, you could pick it out of a lineup.” Rumors about Bacall having a high-pitched, nasal tone that she altered by smoking cigarettes were denied by Bacall, who said her voice was hereditary. Bogart’s equally unique raspy cadence has its own fair share of origin myths, most attached to his scarred lip and subsequent lisp, which inspired claims that he’d sustained a shrapnel injury in the Navy during World War 1. 

Vocal Fatigue Symptoms

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The signs and symptoms of vocal cord overuse can include the following:

  • Husky, hoarse, breathy, or rough voice
  • Tightness or muscle aches in the throat
  • Strained or tight voice
  • Weak or airy voice
  • Sudden breaks or fading of the voice
  • Neck that is tender or sore to the touch
  • Loss of vocal range when singing
  • Feeling the need to clear the throat often
  • Feeling a lump in the throat

Because symptoms vary so widely—and can so often be caused by other underlying conditions—it’s important to be as specific as possible when identifying your issues. The first step is keeping careful track of how often you are using your voice, especially at a lower register. If you’re doing voiceover work, podcasting, or any other audio gig five times a week, for example, it’s worth asking a doctor if that work pace might be causing your symptoms. 

More specifically, medical professionals typically work to identify Bogart-Bacall Syndrome with two methods: 

  • Laryngoscopy: A procedure in which the doctor uses a thin tube outfitted with a small fiber-optic camera to inspect the throat and larynx.   
  • Stroboscopy: A test in which doctors examine the larynx with a rapidly-flashing strobe light, essentially allowing them to see the vocal cords vibrate in slow motion.  

Are Voice Actors at Risk for Bogart-Bacall Syndrome?

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Voice actors of any age are at risk, particularly if you speak in a deeper register than your normal voice for a long period of time. This overuse of vocal cords is something that can occur in theater, film, TV, radio, or podcasting due to the demands of the job. 

Reasons vary about why someone might deliberately lower the frequency of their voice. Working to sound more authoritative is one example that can lead to long-term side effects that put your instrument at risk. Playing a character based on a real person who has a deeper voice than the performer can also cause this shift in pitch, like Amanda Seyfried as Elizabeth Holmes in “The Dropout” or Anne Hathaway’s portrayal of Rebekah Neumann in “WeCrashed.” A character trying to mask their identity (such as Batman) can require a deeper register that may lead to overuse of vocal cords, too. Sustaining this vocal shift over a long period of time without employing preventative techniques will cause damage.

How to Prevent Vocal Fatigue

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It’s important to take good care of your vocal cords just like any other instrument used with regularity. Keep a history of any vocal fatigue, dysphonia, or overuse to aid a diagnosis and help prevent similar issues in the future. Work with a speech pathologist or vocal therapist to learn how to effectively use your voice. An expert can also advise how much fluid and rest are required to ensure vocal cord overuse symptoms are kept to a minimum. Unfortunately, that also extends to your coffee intake. 

“Avoid caffeine as much as possible if you can—it can be dehydrating—and instead switch to decaf tea with tons of honey,” writes vocal coach Theresa Fowler Pittius. “Your vocal folds will thank you later.”

In addition to hydration, there are various immediate measures you can take to lessen the strain on your vocal chords: 

  • Work on your breath control through training—this will prevent tension on the vocal cords. 
  • Take steps to improve your posture, which can limit tension to your larynx.
  • Avoid smoking or passive smoking. 
  • Prioritize resting your voice between jobs. If your voice is your professional instrument, try to limit any unnecessary exertions in your downtime, like screaming or singing. 
  • Talk to your doctor about any underlying conditions that may lead to Bogart-Bacall Syndrome, such as acid reflux or an upper respiratory infection.