Hoarseness is a symptom when there is change in the voice.
The voice may become raspy, strained, unable to reach certain pitch or breathy.
Hoarseness happens when there is an abnormality of the vocal cords. The vocal
cords act like string instruments that come together and vibrates as we speak.
During breathing the vocal cords come apart to allow air to enter the lungs.
CAUSES OF HOARSENESS
Laryngitis
The most common cause of hoarseness is laryngitis; which is
inflammation of the vocal cords. It is usually temporary and related to the
common cold or upper respiratory tract infection. However voice abuse during
bouts of laryngitis can further strain and injure the vocal cords. If the
hoarseness lasts for more than 2 weeks the patient should seek the advice of an
ENT surgeon who would examine the larynx to confirm the cause. Persistent
hoarseness can be an early sign of cancer.
Voice abuse
Excessive straining of the voice can also cause damage to
the vocal cords. Habits of screaming, excessive use or shouting in
noisy environment can also lead to hoarseness. Public speaking for prolonged
periods without use of amplification is also voice abuse.
If the hoarseness happens suddenly after shouting then there
is a possibility that the patient has developed vocal cord hemorrhage. This occurs when the sudden increased pressure on shouting causes a blood vessel to rupture
at the surface of the vocal cord. An assessment by an ENT surgeon can determine
this and treatment is strict voice rest.
Vocal cord lesions
Prolonged hoarseness of more than 2 week should be assessed by
an ENT surgeon as it can be an early sign of cancer.
There are also other benign (non-cancerous) vocal cord
lesions that can present with persistent hoarseness such as vocal cord polyp
and nodules.
Laryngopharyngeal reflux
This is condition when there is stomach acid reflux which
goes all the way up till the larynx or vocal cords. The acidic juice will cause
inflammation of the vocal cords and result in hoarseness.
Smoking
Both primary and secondary smoking can cause hoarseness.
Smokers also have a high risk of developing cancer of the larynx. Therefore
they should not delay consulting an ENT surgeon if they develop hoarseness.
Vocal cord paralysis or palsy
Any impairment of the vocal cords movement can result in hoarseness.
The vocal cords come in a pair and move synchronously to produce voice, pitch
and volume. If one or both the vocal cords are unable to move then the patients
will experience change in voice. Depending on the position of the vocal cords patients amy also have difficulty breathing or choking episodes on drinking fluids. Vocal cord palsy/paralysis can occur due to
neurological conditions, trauma, thyroid disease and other rare causes such as
muscle tension dysphonia or spasmodic dysphonia.
Treatment of hoarseness
The treatment of hoarseness depends on the underlying cause.
Usually doctors would advice voice rest, taking lots of fluids, avoid smoking
and spicy food. Occasionally the help of a speech therapist would be sought.
The therapist is able to teach patients on proper voice usage and how to avoid voice
abuse especially for professional voice users such as singers, teachers,
telephonists and public speakers.
Vocal cord lesions or vocal cord paralysis often need
surgical intervention.
When should patients seek ENT advice?
Since the most common cause of hoarseness is laryngitis then
the initial treatment is given by the family doctor or general practitioner when
patients come in for their common cold. However there are certain signs and
symptoms which should prompt early referral to the ENT surgeon:
1. Persistent hoarseness of more than 2 weeks especially in smokers
2. When there is no associated upper respiratory tract
infection
3. Professional voice users
4. Presence of neck swelling
5. When patients experience difficulty swallowing
6. When patients experience difficulty breathing
7. When there is cough with blood stained sputum
Voice hygiene
This term refers to maintaining the health of the vocal
cords which is mainly avoiding voice abuse. These measures can be practiced:
- Quit smoking
- Avoid secondhand smoke
- Drink plenty of fluids
- Avoid caffeinated drinks and alcohol which can dehydrate the body
- Avoid spicy and oily food
- Try not to use the voice for too long or too loudly
- Humidify the home
- Use of amplification such as microphones when speaking to a crowd
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