Hoarseness: Symptoms, Causes, Treatment

What are the symptoms of hoarseness?

Hoarseness is characterized by changes in the voice, which may include the following symptoms:

1. Raspy or Breathiness: The voice may sound raspy, breathy, or strained.
2. Weak Voice: The voice may be weak or have a reduced volume.
3. Pitch Changes: There may be variations in pitch, such as a higher or lower voice than usual.
4. Vocal Fatigue: The voice may tire easily, making speaking for long periods difficult.
5. Strained Voice: Speaking may require more effort, and the voice may sound strained or tight.
6. Loss of Voice: In severe cases, there may be a complete loss of voice or only a whisper can be produced.
7. Throat Discomfort: There may be a feeling of dryness, soreness, or a lump in the throat.

These symptoms can vary in severity and duration, depending on the underlying cause of the hoarseness. If hoarseness persists for more than a few weeks or is accompanied by other concerning symptoms, it is important to seek medical evaluation.

What are the causes of hoarseness?

Hoarseness can result from a variety of causes, ranging from temporary conditions to more serious underlying issues. Some common causes include:

1. Vocal Strain: Overusing the voice, such as shouting, singing, or speaking for extended periods without rest, can lead to hoarseness.
2. Acute Laryngitis: Inflammation of the vocal cords due to a viral infection, such as a cold or the flu, can cause temporary hoarseness.
3. Chronic Laryngitis: Long-term inflammation of the vocal cords from irritants like smoking, alcohol, or acid reflux (gastroesophageal reflux disease or GERD) can cause persistent hoarseness.
4. Voice Misuse or Overuse: Improper voice use or excessive talking, singing, or yelling can strain the vocal cords.
5. Allergies: Allergic reactions can cause inflammation and irritation of the vocal cords.
6. Gastroesophageal Reflux Disease (GERD): Acid reflux can irritate the vocal cords and lead to hoarseness.
7. Smoking: Smoking irritates the vocal cords and increases the risk of hoarseness and other throat conditions.
8. Vocal Cord Nodules, Polyps, or Cysts: Benign growths on the vocal cords, often due to vocal abuse or misuse, can cause hoarseness.
9. Thyroid Problems: Hypothyroidism (underactive thyroid) can cause vocal cord swelling and hoarseness.
10. Neurological Disorders: Conditions such as Parkinson’s disease, stroke, or spasmodic dysphonia can affect the muscles and nerves controlling the vocal cords.
11. Trauma or Injury: Physical trauma to the throat or vocal cords, including surgery or intubation, can cause hoarseness.
12. Cancer: Tumors of the larynx (voice box) or surrounding areas can cause persistent hoarseness.
13. Autoimmune Diseases: Conditions like rheumatoid arthritis or Sjögren’s syndrome can affect the vocal cords.

If hoarseness persists for more than a few weeks or is accompanied by other concerning symptoms (such as difficulty breathing or swallowing), it is important to seek medical evaluation to determine the underlying cause and appropriate treatment.

How is the diagnosis of hoarseness made?

The diagnosis of hoarseness, also known as dysphonia, is typically made through a combination of a physical examination, medical history, and various diagnostic tests. Here are the steps involved in making a diagnosis of hoarseness:

1. Medical history: The doctor will ask the patient about their symptoms, including the duration and severity of hoarseness, any triggers or factors that worsen or improve the hoarseness, and any associated symptoms such as difficulty swallowing or breathing.
2. Physical examination: The doctor will perform a thorough examination of the patient’s head, neck, and throat to look for any signs of inflammation, lesions, or abnormalities. This may include:
   • Visual examination of the vocal cords using a mirror or fiberoptic scope
   • Palpation (feeling) of the neck and throat to check for any abnormalities
   • Examination of the ears, nose, and throat (ENT) to rule out any other underlying conditions
3. Vocal function tests: The doctor may perform one or more of the following tests to assess vocal function:
   • Stroboscopy: uses a specialized light source to examine the movement of the vocal cords
   • Laryngoscopy: uses a flexible tube with a camera to visualize the vocal cords
   • Videostroboscopy: combines stroboscopy with video imaging to examine vocal cord movement and function
4. Acoustic analysis: The doctor may use equipment to analyze the patient’s voice quality, such as:
   • Spectral analysis: measures the frequency and amplitude of sound waves produced by the voice
   • Pitch and loudness measurements: assesses the patient’s pitch and volume control
5. Imaging tests: In some cases, additional imaging tests may be ordered to rule out any underlying structural abnormalities:
   • CT scan or MRI: may be used to visualize the larynx (voice box) and surrounding structures
   • Ultrasound: can be used to examine the vocal cords and surrounding tissues
6. Laryngeal electromyography (EMG): This test measures the electrical activity of the muscles involved in speech and can help diagnose nerve damage or muscle weakness.

After gathering this information, the doctor will typically make a diagnosis based on the following criteria:

1. Type of hoarseness: Is it chronic or acute?
2. Cause of hoarseness: Is it related to an underlying medical condition, viral infection, or lifestyle factors?
3. Degree of vocal cord involvement: Is there any damage or inflammation affecting the vocal cords?

Based on these findings, treatment options will be discussed with the patient to address the underlying cause and alleviate symptoms.

What is the treatment for hoarseness?

The treatment for hoarseness, or dysphonia, depends on the underlying cause and severity of the condition. Here are some common treatment options:

Conservative treatments:

1. Vocal rest: Avoiding vocal strain and giving the voice time to rest and recover.
2. Warm compresses: Applying a warm compress to the throat to help relieve tension and reduce inflammation.
3. Humidification: Using a humidifier to add moisture to the air, which can help soothe an irritated throat.
4. Speech therapy: Working with a speech-language pathologist (SLP) to improve vocal technique, reduce strain, and increase vocal endurance.
5. Gargling: Gargling with salt water or a throat spray to reduce inflammation and kill bacteria.
6. Pain relief medications: Over-the-counter pain relievers like acetaminophen or ibuprofen can help relieve discomfort.

Medical treatments:

1. Antibiotics: If an underlying infection is causing hoarseness, antibiotics may be prescribed to treat the infection.
2. Anti-inflammatory medications: Steroids or non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce inflammation and swelling.
3. Vocal cord injections: Injecting medication into the vocal cords to reduce swelling and improve voice quality.
4. Throat lozenges: Lozenges that contain ingredients like phenol or menthol can help soothe an irritated throat.

Surgical treatments:

1. Laryngeal surgery: Surgery to remove nodules, polyps, or other growths on the vocal cords.
2. Vocal cord stripping: Surgery to remove excess mucous from the vocal cords.
3. Laser surgery: Laser surgery to remove growths or scars on the vocal cords.

Alternative therapies:

1. Acupuncture: Acupuncture may help reduce stress and promote healing in some cases of hoarseness.
2. Massage therapy: Massage can help relax tense muscles in the neck and throat, which can contribute to hoarseness.
3. Yoga and relaxation techniques: Practicing relaxation techniques like yoga, deep breathing, or progressive muscle relaxation can help reduce stress and promote vocal relaxation.

It’s essential to work with a healthcare provider to determine the best course of treatment for your specific case of hoarseness.