Hoarseness, or dysphonia, 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 or pitch. The changes in sound are usually due to disorders related to the vocal folds, which are the sound producing parts of the voice box (larynx). They come together when speaking or singing, and as air escapes the lungs they vibrate, producing sound. With increased tension and lengthening, the vocal cords vibrate more rapidly and the pitch of the voice will increase. When there is swelling or mucosal abnormalities of the vocal cords they will not come together normally nor vibrate normally, and the voice will sound abnormal. Evaluation of any patient with a voice disorder involves a thorough exam, including a laryngeal examination using fiberoptic or rigid laryngoscopy and video stroboscopy.
There are many causes of vocal cord disorders (i.e. infectious, traumatic, neoplastic, inflammatory, and functional disorders, etc.) Fortunately, most are not serious. The most common cause is a viral upper respiratory infection, which usually occurs due to swelling of the vocal folds and results in decreased vibration and lowering of the pitch. These episodes usually are short-lived (less than two weeks) and respond to supportive treatment only. Another common cause is vocal abuse, which can result in voice changes, which if continuous can lead to a more permanent dysphonia. A common example is the irritation caused by extensive voice use, such as screaming at a sporting event or rock concert. People who consistently misuse their voice may develop a disorder called muscle tension dysphonia in which they use other laryngeal muscles in voice production that are not normally used. This is often misdiagnosed and mistreated. Speech therapy can often successfully treat this. Long-term vocal abuse may result in formation of vocal cord nodules (singer’s or screamer’s nodes). This can cause a lowering of the pitch with voice breaks. Speech therapy can usually successfully treat small nodules and prevent recurrence. The larger nodules generally require both surgical removal and speech therapy.
Other causes of hoarseness include such things as acid reflux into the voice box. This causes irritation of the vocal folds. People will frequently complain of painful swallowing, persistent foreign body sensation in their throat, with frequent throat clearing and thick mucous. Up to 60% of these patients do not complain of classic reflux symptoms such as heartburn. Another common cause of hoarseness is smoking. This may simply be due to chronic irritation of the vocal cords, but also may be due to formation of vocal cord polyps or cysts. Furthermore, one must always keep in mind that any smoker with voice changes or difficulty swallowing may have developed a neoplasm and should be evaluated by an otolaryngologist.
Less commonly, there are a variety of neurologic diseases that can also affect the voice as well as swallowing and should be evaluated.
Dr. Gibbs is fellowship-trained in laryngology / voice disorders.
For additional information or to make an appointment, please contact River Cities Ear, Nose & Throat Specialists, P.L.L.C. at (304) 522-8800 or (800) 955-3277
Scott R. Gibbs, M.D.
Touma Ear and Balance Center
1616 13th Avenue, Suite 100
Huntington, WV 25701
304.522.8800 or 800.955.3277