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Additionally, chronic irritation can cause the vocal cords to become thicker or less flexible over time, which contributes further to a deeper and rougher sound

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10.1016/bs.afnr.2016.11.005 3 ArsenicR.TreueD.LehmannA.HummelM.DietelM.DenkertC.et al (2015)

Nicotine gum is typically available in different strengths, allowing users to start with a higher nicotine content strength and gradually reduce the dose as they progress and are able to deal with the withdrawal symptoms