Hoarseness

Hoarseness is a general term that describes a change in voice quality. When hoarse, the voice may sound breathy, raspy, strained, or there may be changes in volume (loudness) or pitch (how high or low the voice is). The changes in sound are usually due to disorders of the vocal cords, the sound producing parts of the voice box (larynx). Swelling or lumps on the vocal folds prevent them from coming together properly, changing the way the folds vibrate, thereby changing quality, volume, and pitch.

What Are The Causes Of Hoarseness?

Acute Laryngitis
There are many causes of hoarseness. Fortunately, most are not serious and tend to go away in a short period of time. The most common cause is acute laryngitis, which usually occurs due to swelling from a common cold, upper respiratory tract infection, or irritation caused by excessive voice use such as screaming at a sporting event or rock concert.

Vocal Nodules
More prolonged hoarseness is usually due to using your voice either too much, too loudly, or improperly over extended periods of time. These habits can lead to vocal nodules (singer’s nodules). Vocal nodules are common in children and adults who raise their voice in work or play.

Laryngopharyngeal Reflux
Another cause of hoarseness is laryngopharyngeal reflux, which is when stomach acid comes up the swallowing tube (esophagus) and irritates the vocal folds. Many patients with laryngeal reflux do not have symptoms of heartburn. Usually, the voice is worse in the morning and improves during the day. These people may have a sensation of a lump in their throat, mucus sticking in their throat or an excessive desire to clear their throat.

Smoking
Smoking is another cause of hoarseness. Since smoking is the major cause of throat cancer, if smokers are hoarse, they should see an otolaryngologist.

Other Causes
There are many other causes of hoarseness, including allergies, thyroid problems, neurological disorders, trauma to the voice box, cysts, scars, and even the normal menstrual cycle.

Who Can Treat My Hoarseness?

Hoarseness due to a cold or flu may be evaluated by family physicians, pediatricians, and internists who have learned how to examine the larynx. When hoarseness lasts longer than two weeks or has no obvious cause, it should be evaluated by an otolaryngologist–head and neck surgeon (ear, nose and throat doctor). However, professional voice users should be evaluated immediately due to the impact of vocal problems on their livelihood. Problems with the voice are best managed by a team of professionals who know and understand how the voice functions. These professionals are laryngologists, speech/language pathologists, and teachers of singing, acting, or public speaking.

How Is Hoarseness Evaluated?

A laryngologist will obtain a thorough history of the hoarseness and your general health. Your doctor will usually look at the vocal folds with either a mirror placed in the back of your throat, or a very small, lighted flexible tube (fiberoptic scope) passed through your nose. A high-level vocal exam will include videostroboscopy, a slow motion assessment of the vocal cords. This exam is critical for accurate diagnosis of vocal problems and appropriate treatment.

These procedures are not uncomfortable and are well tolerated by most patients. In some cases, special tests (known as acoustic analysis) designed to evaluate the voice, may be recommended. These measure voice irregularities, how the voice sounds, airflow, and other characteristics that are helpful in establishing a diagnosis and guiding treatment.

When should I see a laryngologist (voice doctor)?

• Hoarseness lasting longer than two weeks, especially if you smoke
• Pain not from a cold or flu
• Coughing up blood
• Difficulty swallowing
• Lump in the neck
• Loss or severe change in voice lasting longer than a few days or immediately for a singer

How Are Vocal Disorders Treated?

The treatment of hoarseness depends on the cause. Most hoarseness can be treated by simply resting the voice or modifying how it is used. The laryngologist may make some recommendations about voice use behavior, refer the patient to other voice team members, and in some instances recommend surgery if a lesion, such as a polyp, is identified. Avoidance of smoking or exposure to secondhand smoke (passive smoking) is recommended to all patients. Drinking fluids and possibly using medications to thin the mucus are also helpful.

Specialists in speech/language pathology (voice therapists) are trained to assist patients in behavior modification that may help eliminate some voice disorders. Patients who have developed bad habits, such as smoking or overuse of their voice by yelling and screaming, benefit most from this conservative approach. The speech/language pathologist may teach patients to alter their method of speech production to improve the sound of the voice and to resolve problems, such as vocal nodules. When a patient’s problem is specifically related to singing, a singing teacher may help improve the patients’ singing techniques.

What Can I Do to Prevent and Treat Mild Hoarseness?

• If you smoke, quit.
• Avoid agents that dehydrate the body, such as alcohol and caffeine.
• Avoid secondhand smoke.
• Drink plenty of water.
• Humidify your home.
• Watch your diet – avoid spicy foods.
• Try not to use your voice too long or too loudly.
• Use a microphone if possible in situations where you need to project your voice.
• Seek professional voice training.
• Avoid speaking or singing when your voice is injured or hoarse