As part of our services, we offer treatments in the new specialty
of PERFORMING ARTS MEDICINE. which includes vocal,
instrumental and dance medical problems.
A patient asks: "Doctor, Why Am I Hoarse?"
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?
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 their Physician.
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 other physicians (who have learned
how to examine the larynx). When hoarseness lasts longer than two
weeks or has no obvious cause it should be evaluated more
aggressively. Problems with the voice are best managed by a team of
professionals who know and understand how the voice functions. These
professionals are Physicians trained in voice medicine,
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?
A Physician 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 (fiber optic scope) may be passed
through your nose in order to view your vocal cords.
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 a 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 physician 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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