Voice strain; Dysphonia; Loss of voice
Hoarseness is described as having difficulty producing sound when trying to speak, or a change in the pitch or quality of the voice. The voice may sound weak, excessively breathy, scratchy, or husky.
Hoarseness is usually caused by a problem in the vocal cords. Most cases of hoarseness are associated with inflammation of the larynx (laryngitis).
Persistent hoarseness (hoarseness that lingers for weeks or months) may be caused by a variety of problems ranging from trivial to dangerous.
- Excessive use of the voice (as in shouting or singing)
- Inhaling irritating substances
- Excessive use of alcohol or tobacco
- Coughing (may be caused by allergies or some diseases such as bronchitis)
- In children, prolonged or excessive crying
- Viral illness
- Gastric reflux (acid from the stomach irritating the voice box)
Other causes include:
- Heavy smoking and drinking, especially in combination
- Overall weakness caused by other diseases
- Ingestion of a caustic liquid
- Foreign body in the esophagus or trachea (see foreign object aspiration or ingestion)
- Infectious mononucleosis
- Postnasal drip
- Vocal cord nodules or paralysis (post-surgical)
- Bronchoscopy or other tests (temporary)
- Cancer of the voice box (laryngeal cancer)
Hoarseness may be acute or chronic, but is treated the same in most cases.
Rest and time are really the only way to cure hoarseness that is not associated with other symptoms. This kind of hoarseness is very resistant to medical therapy. Crying, shouting, and excessive talking or singing will only worsen the problem. Be patient, the healing process may take several days. Don’t talk unless it is absolutely necessary and avoid whispering. Whispering can strain the vocal cords more than speaking does.
Gargling has no therapeutic effect on the vocal cords. Avoid decongestants because they dry the vocal cords and prolong irritation. If you smoke, reduce or stop smoking.
Humidifying the air with a vaporizer or drinking fluids can offer some relief.
Other underlying disorders such as bronchitis, allergies, laryngitis, or alcoholism should be treated.
Call your health care provider if
- There is difficulty in breathing or swallowing.
- Hoarseness is accompanied by drooling, especially in a small child.
- Hoarseness is present in a child less than 3 months old.
- Hoarseness has lasted for more than 1 week in a child, or 2 weeks in an adult.
What to expect at your health care provider’s office
If there is severe difficulty breathing, the first priority is to ensure normal breathing. This may require the placement of a breathing tube. Once the condition is stable, the medical history will be obtained and a physical examination performed.
Medical history questions documenting hoarseness or changed voice in detail may include:
- Quality o Is your (or your child’s) voice hoarse? o Did you lose your voice completely? o Is the voice weak? o Does it sound breathy, scratchy, or husky?
- Time pattern o Does the voice change refuse to go away completely (persistent)? o Does the voice change occur repeatedly (recurrent)? o Has the condition worsened gradually over time? o Is it continuous (does not change intensity over time)? o At what age did the voice change begin? o How long has this symptom been present?
- Aggravating factors o Have you been shouting, singing, or otherwise overusing your voice? o Has there been an exposure to irritating fumes? o Has there been ingestion of a caustic liquid? o Has there been a foreign object aspiration or ingestion? o Do you use alcohol? o Do you smoke? o Do you have a history of allergies? o If an infant or child, has there been prolonged crying? o Has there been a recent surgery or procedure on the mouth or throat?
- Other o What other symptoms are present? o Is there a fever? o Is there malaise? o Is there coughing? o Is there weakness? o Is there a sore throat? o Is there fatigue? o Is there postnasal drip?
The physical examination will include a detailed examination of the mouth and throat.
Diagnostic tests that may be performed include:
- Blood tests such as CBC or blood differential
- Throat examination with small mirror
- X-rays of the neck
- Laryngoscopy (visualization of the larynx with a laryngoscope)
- Throat culture
Thickened cords, polyps, and benign nodules can all be treated surgically or with a laser. Cancers are sometimes completely cured by either surgery, radiation, or both. Vocal cords that are accidentally damaged while administering anesthesia or during surgery can often be repaired.
Other conditions may benefit from voice rest and speech therapy. Reflux laryngitis is treated with anti-reflux measures (avoid spicy and fried food, reduce coffee intake) and antacids.
Stopping smoking helps in early recovery from laryngitis and other conditions causing hoarseness.
After seeing your health care provider:
If a diagnosis was made by your health care provider related to hoarseness or changed voice, you may want to note that diagnosis in your personal medical record.
by Armen E. Martirosyan, M.D.