| What is
hoarseness? Hoarseness
is a general term which describes
abnormal voice changes. 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
related to the vocal folds which are
the sound producing parts of the
voice box (larynx) (see A). While
breathing, the vocal folds remain
apart (see B). When speaking or
singing, they come together (see C),
and as air leaves the lungs, they
vibrate, producing sound. The more
tightly the vocal folds are held and
the smaller the vocal folds, the
more rapidly they vibrate. More
rapid vibration makes a higher voice
pitch. Swelling or lumps on the
vocal folds prevent them from coming
together properly, which makes a
change in the voice.
What are
the causes?
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
causes are acute laryngitis
which usually occurs due to swelling
from a common cold, upper repiratory
tract viral infection, or irritation
caused by excessive voice use such
as screaming at a sporting event or
rock concert.
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 (singers' nodes),
which are callous-like growths, or
may lead to polyps of the vocal
folds (more extensive swelling).
Vocal nodules are common in
childrena nd adults who raiase their
voice in work or play. Uncommonly,
polyps or nodules may lead to
cancer.
A common cause of hoarseness in
older adults is
gastroesophageal reflux,
when stomach acid comes up the
swallowing tube (esophagus) and
irritates the vocal folds. Many
patients with reflux-related changes
of voice do not have symptopms 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, mucous sticking in their
throat or an excessive desire to
clear their throat.
Smoking is another cause
of hoarseness. Since smoking as a
major cause of throat cancer, if
smokers are hoarse, they should see
an otolaryngologist.
Many unusual causes for
hoarseness include allergies,
thyroid problems, neurological
disorders, trauma to the voice box
and occasionally the normal
menstrual cycle. Many people
experience some haorseness with
advanced age
Who can
treat my hoarseness?
Hoarseness due to a copld 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 byy an aotolaryngologist-head
and neck surgeon (ear, nose and
throat doctor). Problems with the
voice are best managed by a team of
professionals who know and
understand how the voice functions.
These professionals are
otolaryngology-head and neck sugeons,
speech/language pathologists, and
teachers of singing, acting, or
public speaking. Voice disorders
have many different characteristics
which may gove professionals a claue
to the cause.
When
should I see an otolaryngologst (ENT
doctor)?
- If hoarseness lasts longer
than 2-3 weeks
-
- If hoarseness is
associated with:
- Pain not froom a cold or
flu
- Coughing up blood
- Difficulty swallowing
- A lump in the neck
- Complete loss or severe
change in voice lasting longer
than a few days
How is
hoarseness evaluated?
An otolaryngologist will obtain a
thorough history of the hoarseness
and your general health. Your doctor
will usually look at the vocal folds
with a mirror placed in the back of
your throat. Occasionally a very
small lighted flexible scope (fiberoptic
tube scope) may need to be passed
through your nose (or in some cases,
a rigid scope may be used which is
placed in the back of your mouth) in
order to view your vocal folds.
Videotaping the examination may also
help with the analysis.
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 (acoustic content),
airflow and other characteristics
that are helpful in establishing a
diagnosis and guiding treatment.
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
otolaryngologist may make some
recommendations about the voice use
behavior, refer the patient to other
voice team members, and in some
instances recommend surgery if a
discreet lesion, such as a nodule or
polyp, is identitfied. Avoidance of
smoking or exposure to secondhand
smoke (passive smoking) is
recommended to all patients.
Drinking fluids is also helpful.
Specialists in speech/language
pathology are trained to assist
patients in behavior modification
which may help elimiate some voice
disorders. Sometimes, patients have
developed bad habits, such as
smoking or overuse of their voice by
yelling and screaming, which may
cause the voice disorder. The
speech/language pathologist may
teach patients to alter their method
of speech productions 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, as
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 which dehydrate
the body, such as alcohol and
caffeine
- Avoid secondhand smoke
- Drink plenty of water
- Humidify your home
- Watch your diet — avoid
spicy foods and alcohol
- Try not to use your voice
too long or too loudly
- Seek professional voice
training
- Avoid speaking or singing
when your voice is injured or
hoars (this is similar to not
walking on a sprained ankle)
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