Hoarseness is a general term that describes abnormal voice changes. When hoarse, a patient's voice may sound breathy, raspy, strained or there may be changes in volume or pitch. The changes in sound are usually due to disorders related to the vocal cords (the sound producing parts of the voice box). While breathing, the vocal cords remain apart but when speaking or singing, they come together, vibrate, producing sound. Swelling or lumps on the vocal cords prevent them from coming together properly and changes the way the cords vibrate, which makes a change in the voice, altering quality, volume and pitch.
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 cause is acute laryngitis, which usually occurs due to swelling from a common cold, upper respiratory tract viral infection or irritation caused by excessive voice use such as screaming at a sporting event or rock concert.
Vocal Nodules or Polyps:
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 cords (more extensive swelling). Both of these conditions are benign. Vocal nodules are common in children and adults who raise their voice in work or play.
A common cause of hoarseness is gastro-esophageal reflux, when stomach acid comes up the swallowing tube (esophagus) and irritates the vocal cords. Many patients with reflux-related changes of voice 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 is another cause of hoarseness. Since smoking is the major cause of throat cancer, if smokers are hoarse, they should see a physician.
Other causes for hoarseness include allergies, thyroid problems, neurological disorders, trauma to the voice box and occasionally, the normal menstrual cycle.
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. A physician may make 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 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 patients’ 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 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
Try not to use your voice too long or too loudly
Use a microphone in situations where you need to protect your voice
Seek professional voice training
Avoid speaking or singing when your voice is injured or hoarse
Don’t sing when you are sick
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 (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 including otolaryngologists, speech/language pathologists and teachers of singing, acting, or public speaking.
How Is Hoarseness Evaluated?
Thorough history of the hoarseness and your general health is needed. A physician will usually look at the vocal cords with either a mirror placed in the back of your throat or a very small, lighted flexible tube (fiber optic scope) may be passed through your nose in order to view your vocal cords. Videotaping the examination or using stroboscopy (slow motion assessment) 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, airflow and other characteristics that are helpful in establishing a diagnosis and guiding treatment.
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