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Many believe it was from smoking when she was younger and singing in smoke filled clubs

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The film seemingly doesn't take this position

In addition, the mechanical friction generated by chewing and the chemical irritants contained in areca nut contribute to chronic mucosal trauma and facilitate the development of pathological changes (33)

Smoking also makes a person more susceptible to health conditions that can cause a sore throat, including a cold, the flu, and respiratory tract infections