Hoarseness

What is hoarseness?

Hoarseness may be described as an abnormal change in the voice, making it sound strained and raspy, probably with changes in the pitch and volume. 

What are its causes and concerns?

Hoarseness can result from a disorder of the vocal cords (sound-producing parts) in the larynx (voice box). Our vocal cords come close together when we speak or sing but remain separated while we are breathing. As air escapes from the lungs, the vocal cords vibrate and produce sounds. When these cords swell or have lumps, these vibrations are hampered, changing the volume, pitch and/or quality of the voice. 

Some common causes of hoarseness are:

• Acute Laryngitis – may cause swelling of the vocal cords due to voice strain, common colds or upper respiratory tract infections. It is the most prevalent cause of hoarseness.
• Benign vocal cord lesions – overuse of the voice or speaking too loudly for a prolonged period can lead to the formation of polyps, cysts or nodules (callus-like vocal cord growths) on the vocal cords. This may result in hoarseness. However, cysts and polyps may develop even if the voice is not misused.
• Vocal haemorrhage – or vocal cord haemorrhage, refers to sudden loss of voice after yelling or some other strenuous use of the voice. A blood vessel may rupture on the surface of the cords, resulting in the soft tissues filling with blood. This is considered a vocal emergency and a throat specialist (otolaryngologist) should be consulted. One must give total rest to the voice in case of this condition.
• Gastro-oesophageal Reflux (GERD) – refers to irritation of the vocal cords due to stomach acids backing up into the oesophagus (swallowing tube). Some symptoms of GERD are regurgitation and/or heartburn, feeling that you have a lump and/or mucus in the throat and having a constant urge to clear it. Usually, patients find the condition of their voice to be worse in the morning than later in the day.
• Laryngopharyngeal Reflux (LPRD) – refers to when the reflux reaches the back part of the throat. Since the larynx, pharynx and lungs are very sensitive to stomach acids/digestive enzymes, small amounts of reflux can cause more damage.
• Smoking – is considered to be the leading cause of hoarseness. Smokers should keep a lookout for hoarseness and consult a throat specialist if they observe any symptoms. 
• Neurological disorders – like Parkinson’s, stroke or spasmodic dysphonia (a rare neurological disorder affecting only the voice and occasionally breathing) may also cause hoarseness. Paralysis of vocal cords could weaken the voice. If hoarseness persists for longer than three months and no other reasons have been found for it, you must consult a throat specialist to get yourself examined.
• Damage to the larynx, allergies, thyroid conditions, laryngeal cancer are some other causes of hoarseness. 

Prolonged hoarseness should not be ignored as it can have serious repercussions. Consider seeing a throat specialist to get your condition evaluated.

What are its symptoms?

Hoarseness may be characterised by many symptoms, some of which may indicate a serious underlying problem. They are:

• Difficulty swallowing
• A lump in the neck or throat
• Pain when speaking and swallowing
• Changes in the voice which last for more than a few days
• A singer who cannot perform
• Difficulty breathing along with change(s) in the voice
• Coughing up blood
• Hoarseness that stays for more than three weeks, especially if you are a smoker
• No other symptoms of a cold/flu

What are the solutions and treatment options?

To suggest a course of treatment, our throat specialist must conduct a thorough evaluation of your case, which involves taking your complete medical history and performing a physical examination. After evaluating your voice, the doctor may advise a laryngoscopy to examine your vocal cords. If the doctor suspects a serious cause for the hoarseness, the laryngoscopy may have to be performed immediately.

As with all illnesses, treatment depends upon the cause of hoarseness. In most cases, the doctor would recommend that you rest your voice or engage in simple voice modification behaviours. However, if required, he or she may refer you to other specialists.

In conclusion

As always, prevention is better than cure. Even if your hoarseness is caused by something else, it is always in your best interest to not smoke and stay away from second-hand smoke. If you notice symptoms of hoarseness in yourself or someone you love, do not ignore them! Contact us for an appointment. Our throat specialist will help you find a solution to your problems.

Additional Reading: http://www.entnet.org/HealthInformation/hoarseness.cfm