Hoarseness

Hoarseness is a symptom and not a disease. It is a general term that 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). There are many causes of hoarseness; fortunately, most are not serious and tend to go away in a short period of time. If hoarseness persists longer than two weeks, a visit to your physician is recommended. While not always the case, persistent hoarseness can be a warning sign of cancer.

Causes

• Common cold or upper respiratory tract viral infection
• Voice abuse: when you use your voice either too much, too loudly, or improperly over extended periods of time.
• Gastroesophageal reflux: when stomach acid comes up the swallowing tube and irritates the vocal folds
• Smoking
• Allergies, thyroid problems, neurological disorders, rheumatoid arthritis and trauma to the voice box

Diagnosis

• A thorough history of your hoarseness and your general health is obtained.
• Voice box and surrounding tissue will be examined using a mirror or a laryngoscope, a small lighted flexible instrument placed in the back of your throat.
• Voice quality is then evaluated: ~ A breathy voice may suggest poor vocal cord function, which may be caused by a benign tumor, polyp or cancer of the larynx.
  ~ A raspy voice may indicate vocal cord thickening due to swelling, inflammation from infection, a chemical irritant, voice abuse or paralysis of the vocal cords.
  ~ A high, shaky voice or a soft voice may suggest trouble getting enough breathing force or air.
• Lab tests, such as a biopsy, x-rays, thyroid function may be ordered depending on the findings of the physical exam.

Treatment
Treatment varies depending on the condition causing the hoarseness.

• Most hoarseness can be treated by simply resting the voice or modifying how the voice is used.
• If smoking is related to the hoarseness, you may be advised to stop smoking, as well as resting your voice.
• For all patients, it is recommended to avoid smoking or the exposure to second hand smoke and drink plenty of fluids.
• Surgery may be recommended if there are nodules or polyps on the vocal folds.

Prevention

• If you smoke, quit
• Avoid agents which dehydrate the body, such as alcohol and caffeine
• Avoid “second hand” (passive) smoke
• Humidify your home
• Watch your diet – avoid spicy foods and alcohol
• Try not to use your voice too long or too loudly
• Seek professional help if your voice is injured or hoarse