Hoarseness

Hoarseness refers to a change in the voice. When hoarse, the voice may sound husky, breathy, raspy or strained. There may be changes in volume (loudness) or pitch (how high or low the voice is).

Changes in the voice are usually due to disorders related to the vocal folds/cords, which are the sound-producing parts of the voice box (larynx). The vocal folds move apart when you breathe and come together when you speak or sing. They vibrate as air leaves the lungs, producing sound.

Any swelling or lumps on the vocal folds will stop them from coming together properly, which will cause the voice to change.

What Causes Hoarseness?

There are many causes of hoarseness. Fortunately, most are not serious and resolve spontaneously. The most common cause is acute laryngitis, which usually occurs due to swelling from an upper respiratory tract infection or irritation caused by excessive voice use.

Smoking is a cause of more prolonged hoarseness (i.e. lasting longer than four weeks). Since smoking is the major cause of throat cancer, if smokers are hoarse, they should see an Ear, Nose and Throat Surgeon.

Another cause of prolonged hoarseness is excessive voice use or abuse, i.e. using your voice either too much, too loudly or improperly over a period of time. These habits can lead to vocal nodules singer’s or screamer’s nodules), which are callus-like growths, or may lead to more extensive swelling (vocal polyps). It is extremely rare for nodules or polyps to lead to cancer.

A common cause for hoarseness in adults is gastro-oesophageal reflux, when acid from the stomach comes up the gullet (oesophagus) and irritates the vocal folds. These patients often do not have heartburn but may feel a lump in the throat or mucous sticking in their throat.

In children, warts (papillomata) can cause hoarseness from an early age.  This is sometimes associated with noisy breathing.

Who Can Treat My Hoarseness?

A family doctor can check hoarseness due to an upper respiratory tract infection or voice strain.  It is important to see an Ear, Nose and Throat Surgeon to exclude serious causes of hoarseness, e.g. cancer, if:

1. The hoarseness lasts more than 4 weeks.
2. Complete hoarseness or severe change lasts longer than a few days
3. The hoarseness is associated with:

• Pain
• Coughing up blood
• Difficulty swallowing
• A lump in the neck
• Difficulty breathing, or noisy breathing

How is hoarseness evaluated?

An ORL surgeon will take a history of your problem and examine you. The vocal folds will be examined using a flexible laryngoscope (endoscope), which is passed through your nose.   Alternatively, a mirror, or a rigid scope, may be placed in the back of your mouth to view the vocal folds.  In some cases, you may be referred to a voice laboratory for special tests (acoustic analysis).

How are Vocal Disorders Treated?

• The treatment depends on the cause.  However, most patients can be treated by simple measures – voice rest, steam inhalations, and maintaining a good fluid intake.
• Avoidance of smoking, including second-hand smoke, is recommended.
• Associated conditions, e.g. Reflux, may also need to be treated.
• You may require a referral to a speech therapist trained to assist in voice modification, which may eliminate some voice disorders.   This can sometimes resolve vocal nodules.
• A singing teacher can sometimes be of help.
• Surgery may be recommended if a discrete lesion, e.g. polyp, is identified.  This helps to confirm the diagnosis, as the lesion is sent to a pathologist.   It may also improve the quality of the voice.   If cancer is suspected, this will be managed appropriately.

Care of the Voice

1. 1. GIVE UP SMOKING
   2. Avoid clearing your throat or coughing – swallow instead
   3. Avoid yelling and screaming
   4. Avoid speaking to large audiences without the aid of a microphone
   5. Avoid whispering
   6. Avoid using your voice when you have a cold or other upper respiratory tract infections.
   7. Drink more water and less tea/coffee – keep your throat moist – avoid getting a dry throat.
   8. Turn the radio or TV down to avoid raising your voice to be heard above it
   9. Rest your voice after prolonged talking or singing
   10. Wave a flag, clap your hands etc. at a sports event instead of yelling
   11. Move away from noisy machinery or closer to the person you are speaking to in noisy places
   12. Relax, keep fit and avoid bottling up your feelings
   13. Seek help if you think you have a voice problem. See your GP and ENT surgeon or a Speech Therapist.