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What Is Hoarseness?
Hoarseness 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 cords that are the sound producing parts of the voice box (larynx).
While breathing, the vocal cords remain apart. When speaking or singing,
they come together, and as air leaves the lungs, they 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 Of Hoarseness?
Acute Laryngitis: 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: 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.
Gastroesophageal Reflux: 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: Smoking is another cause of
hoarseness. Since smoking is the major cause of throat cancer, if
smokers are hoarse, they should see an otolaryngologist.
Other Causes: Many unusual causes for hoarseness
include allergies, thyroid problems, neurological disorders, trauma to
the voice box, and occasionally, the normal menstrual cycle.
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--head and neck surgeon (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. These professionals are
otolaryngologist--head and neck surgeons, speech/language pathologists,
and teachers of singing, acting, or public speaking. Voice disorders
have many different characteristics that may give professionals a clue
to the cause.
How Is Hoarseness Evaluated?
An otolaryngologist will obtain a thorough history
of the hoarseness and your general health. Your doctor 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 (fiberoptic 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
When should I see an otolaryngologist (ENT doctor)?
-
Hoarseness lasting longer than two weeks especially if you smoke
-
Pain not from a cold or flu
-
Coughing up blood
-
Difficulty swallowing
-
Lump in the neck
-
Loss or severe change in voice lasting longer than a few days
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. The otolaryngologist may make some 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 possibly 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 that 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 if possible in situations where you need to
project your voice.
- Seek professional voice training.
- Avoid speaking or singing when your voice is injured or hoarse.
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