Selena Gomez says vaping has changed her voice. Can e-cigarettes really affect your vocal cords – and is it reversible?

While vaping is known to cause lung damage, breathlessness and nicotine addiction, the singer and actor Selena Gomez has posted in a video on Instagram that vaping has permanently changed her voice.

“Nicotine is so hard to quit and I just wanted to say, if you’re going through it, or if you’re even trying to vape, it’s just not worth it,” she said. “It’s so stupid and it changed my voice. I’m not going to be able to change my voice. I vaped a lot.”

Gomez also has lupus, an autoimmune condition in which the body mistakenly attacks healthy tissues, organs and cells and which can cause inflammation affecting the vocal cords.

But can vaping also affect one’s voice – and if so, are the changes reversible?

What does vaping do to the vocal cords?

Prof Matthew Peters, a professor of respiratory medicine at Macquarie University hospital, says: “We don’t have a way of delivering nicotine to the voice box that’s not in a harmful vehicle, whether it’s cigarette smoking, vaping, or heat not burn.”

The tissues of the upper airway are delicate, he says, and heated products – which may contain toxic chemicals and ultrafine particles that can be inhaled deep into the lungs – affect the vocal cords or vocal folds, located inside the larynx (voice box).

Epithelial cells are part of the outer, protective layer of the vocal cords known as the epithelium, working as “the first line of defense against inorganic, organic and microbial intruders,” a paper published in the journal Disease Models and Mechanisms says.

Vaping damages these cells, causing them to detach, and triggering inflammation and swelling – sometimes leading to a hoarse, deep or raspy voice.

Prof Peter Wark, a spokesperson for the National Asthma Council Australia and a respiratory physician, says vaping also impacts the mucous membrane, which dries out and thins when damaged. Wark says this increases “the risk of coughing and breathing difficulties”.

Peters says vaping has “toxic effects” on the entire upper respiratory system.

“The whole voice system is very finely tuned to generate the noises that we do, and it does not take much of a inflammatory change to alter voice, particularly in heavy voice users.”

Is the damage reversible?

While the evidence for the harms of cigarettes has been accumulating for 200 years, vapes began appearing more commonly in the 2000s and Wark says it means the evidence for vocal damage is “very strong in the short term, but less well defined in the longer term”.

“Up to a third of people vaping report symptoms of chronic cough from studies in the US and China,” he says.

“Similar numbers have also been shown to experience hoarse voice or dysphonia [voice impairment]. There are no longitudinal studies that demonstrate permanent changes, or changes that do not resolve with cessation. However, this is possible and it will take time for the evidence to come through.”

Peters says complaints about voices are more frequent in those who have quit vaping than in those who continue to vape.

“That’s a bit of a paradox in some ways, but it could be that the people who are concerned about their voice stop vaping, and then it doesn’t always immediately improve. So clearly, these products alter voice quality. The chance of recovery after cessation is not substantiated one way or the other from data.”

Do non-nicotine vapes cause similar harm?

Wark says while it is not clear that nicotine itself worsens these symptoms, all vapes – whether they are non-nicotine or flavoured – cause similar harms to the vocal cords and respiratory system.

“I recommend that no one should use vapes,” he says. “If they develop cough or hoarse voice they should certainly stop as it will worsen. Recent evidence suggests that vaping can also worsen asthma control and lead to increased symptoms and the need to use anti-inflammatory inhalers.”

Peters says when vapes were first becoming more common, he advocated that they be treated with caution until any harms were known.

“I now think we should be regulating and approaching electronic cigarettes generally on the basis of proven harm, not precaution,” he says.

“Those harms go from asthma to respiratory symptoms to impaired immunity and frequent episodes of pneumonia, with emerging evidence on other things like heart attacks.

“The full spectrum of the harms and extent might require some clarification over time. It’s genuinely doubtful whether, in fact, long-term intense vaping is any safer than long-term smoking.”

He praised Gomez for being open about her experience.

“I think that’s a really good message for a prominent celebrity who’s had some health battles well publicised; that she doesn’t want to have other people to have the health battles that she has experienced.”