Most adults and children have experienced hoarseness at one time or another. For some, it is a seasonal occurrence caused by allergies. For others, hoarseness occurs after too much yelling at a sporting event or in conjunction with an upper respiratory infection.
Hoarseness, also known as Dysphonia, is best described as a change in, or a lack of, normal quality of voice. Typically, hoarseness from overuse or viral infections will go away within several days. However, if hoarseness persists (a condition referred to as Chronic Dysphonia), an Otolaryngologist (Ear, Nose and Throat [ENT] Doctor) should be promptly consulted for further evaluation.
A patient’s medical and social histories are both very important in the evaluation of Chronic Dysphonia. Knowledge of previous tobacco and alcohol use and of prior surgeries or intubations, along with an understanding of the way a person typically uses his or her voice, is essential in determining why hoarseness has occurred. Other medical factors, such as the presence of a neck mass or a preexisting throat or respiratory disorder, can also be underlying causes of Dysphonia.
It is very important to schedule an examination with an Otolaryngologist if:
- The patient’s hoarseness has lasted more than 30 days.
- The patient also has a new lump in the neck, has experienced weight loss, or is coughing up blood.
- The patient experiences hoarseness along with ear pain when swallowing.
- The patient has a history of significant tobacco and alcohol use.
Diagnosing Persistent Hoarseness
Evaluation of Chronic Dysphonia at CornerStone Ear, Nose & Throat involves examination of the larynx (the voice box) and all surrounding parts of the throat. In some cases, a mirror can be used to indirectly look down a patient’s throat to determine the cause of hoarseness. Flexible Fiberoptic Laryngoscopy, which is performed in the doctor’s office, can be used for better visualization and a more accurate diagnosis. Numbing spray is applied to the nasal passage to allow a flexible endoscope to easily pass through the nose. Fiberoptic Laryngoscopy allows the physician to thoroughly and painlessly evaluate a patient’s upper and lower throat and larynx.
Causes of Hoarseness
Hoarseness is common for patients who have swollen, red, and irritated vocal cords; frequent throat clearing; a persistent burning sensation in the throat; or phlegm in the throat that cannot be cleared. These complaints and the accompanying hoarseness are often caused by Laryngopharyngeal Reflux (LPR), a condition in which acidic contents of the stomach and digestive enzymes escape back up into the throat. This most commonly occurs while people are lying flat or sleeping (this condition was formerly known as “silent reflux”). Most patients with LPR do not experience reflux while awake, nor do they usually have any of the typical heartburn symptoms associated with the more common Gastro-Esophageal Reflux Disease (GERD).
CornerStone Ear, Nose & Throat frequently helps patients understand how simple lifestyle modifications can lessen the bothersome symptoms of LPR. An acid-reducing medication can be prescribed for additional relief.
Overuse of the Voice
Teachers, professional singers, athletic coaches, and other people who frequently use their voice for work commonly experience prolonged Dysphonia due to the overuse of their vocal cords. When a voice is aggressively used, the vocal cords vibrate in unison and come in contact with each other. This vibration can result in inflammation or edema, both of which can resolve in several days; however, repetitive injury to or overuse of the voice causes the vocal cords to thicken with growths over time. (Think of it as similar to the manner in which calluses form on hands during repetitive motion.) These growths are referred to as vocal cord nodules, which typically create a lower-pitched and breathy voice. When trying to compensate for this condition, patients often develop muscle-tension dysphonia, another form of hoarseness. As the name suggests, this disorder can cause a person’s voice to persistently sound very strained. Treatment for this type of hoarseness usually requires resting the voice for an extended period. Voice therapy with a qualified Speech and Language Pathologist might be needed.
Vocal Cord Polyps and Growths Due to Smoking
Chronic Dysphonia can be caused by vocal cord polyps. These growths on the vocal cords are typically benign but often require surgical removal for the normal sound of a person’s voice to be restored. Patients who have smoked for many years might experience hoarseness from something that looks similar to a polyp but is actually Reinke’s edema, in which an inner tissue layer of the vocal cords becomes thickened, resulting in a raspy “smoker’s voice.” Although usually benign, hoarseness caused by Reinke’s edema can be permanent. Surgical correction is possible but is not considered an option unless all smoking and exposure to smoke are discontinued prior to the procedure.
Occasionally during the laryngoscopy procedure, white frothy plaque resembling yeast is observed. The presence of this substance typically suggests a fungal infection caused by yeast (a type of fungus) known as Candida. Most commonly found in patients with compromised immune systems or who rely on corticosteroid inhalers, this condition can also cause hoarseness. Successful treatment is usually possible with antifungal medication in the form of a pill or a solution that is swished and swallowed.
Allergies and Chronic Sinus Disorders
Patients who suffer from persistent coughing, throat clearing, and excessive postnasal drainage associated with allergies and chronic sinus infections often experience prolonged Dysphonia. Fortunately, appropriate diagnosis and medical management of these underlying conditions will usually reduce hoarseness.
Hoarseness can occur after certain operations or due to irritation caused by passing a breathing tube through the larynx as part of the anesthesia. Although this type of Dysphonia usually goes away over time, lasting or permanent hoarseness can be the result of post-surgical scar tissue, displacement of the cartilages that move the vocal cords (arytenoid dislocation), or granulomas. Specific surgical procedures, such as thyroidectomy, parathyroidectomy, or any operation performed in the chest cavity (thoracotomy) can result in vocal cord paralysis or weakness that also causes hoarseness. This condition is a result of the associated nerve’s being compromised during surgery.
Vocal Cord Immobility and Paralysis
Hoarseness caused by vocal cord immobility can also be a sign of something more concerning, such as the compression of the recurrent laryngeal nerve by a mass or tumor in the chest. Or vocal cord paralysis might not be associated with any identifiable health concern, in which case it is then called “idiopathic” vocal cord paralysis; however, that diagnosis can be made only after thorough evaluation and workup by an experienced Otolaryngologist.
Unfortunately, chronically hoarse patients and primary care providers do not have the luxury of being able to see the vocal cords. So if hoarseness persists for more than 30 days, it is important to have an evaluation by an ENT specialist.
For more information or to schedule a patient appointment, please call CornerStone Ear, Nose & Throat at 704-752-7575.