WHAT IS HOARSENESS?

Hoarseness refers to a change in the voice. When hoarse, the voice may sound husky, breathy, raspy or strained. There may be changes in volume (loudness) or pitch (how high or low the voice is).

Changes in the voice are usually due to disorders related to the vocal folds/cords, which are the sound-producing parts of the voice box (larynx). The vocal folds move apart when you breathe, and come together when you speak or sing. They vibrate as air leaves the lungs, producing sound.

Any swelling or lumps on the vocal folds will cause the voice to change.

WHAT CAUSES HOARSENESS?

There are many causes of hoarseness. Fortunately, most are not serious, and resolve spontaneously. Any swelling or lump on the vocal folds will cause the voice to change.

The commonest cause is acute laryngitis, which usually occurs due to swelling of the vocal cord lining from an upper respiratory tract infection, or from irritation caused by excessive voice use.

Smoking is a cause of more prolonged hoarseness (i.e. lasting longer than 4 weeks). Since smoking is a major cause of throat cancer, if smokers are hoarse, they should see an Ear, Nose and Throat Surgeon.

Another cause of prolonged hoarseness is excessive voice use or abuse, i.e. using your voice either too much, too loudly or improperly over a period of time. These habits can lead to vocal nodules (also known as singer’s or screamer’s nodules), which are callus-like growths, or may lead to more extensive swelling (vocal polyps). It is extremely rare for nodules or polyps to lead to cancer.

A common cause for hoarseness in adults is gastro-oesophageal reflux, when acid from the stomach comes up the gullet (oesophagus) and irritates the vocal folds. These patients often do not have heartburn, but may have a sensation of a lump in the throat, or mucus sticking in their throat.

In children, warts (papillomata) can cause hoarseness from an early age. This is sometimes associated with noisy breathing.

WHO CAN TREAT MY HOARSENESS?

A family doctor can check hoarseness due to an upper respiratory tract infection or to voice strain.

It is important to see an Ear, Nose and Throat Surgeon to exclude serious causes of hoarseness, e.g. cancer, if:

1) The hoarseness lasts longer than 4 weeks

2) Complete hoarseness or severe change lasts longer than a few days

3) The hoarseness is associated with:

• -pain
• -coughing up blood
• -difficulty swallowing (dysphagia)
• -a lump in the neck
• -difficulty breathing, or noisy breathing

HOW IS HOARSENESS EVALUATED?

An ENT surgeon will take a history of your problem, and examine you. The vocal folds will be examined using a flexible laryngoscope (endoscope), which is passed through your nose. Alternatively, a mirror, or a rigid scope, may be placed in the back of your mouth to view the vocal folds. In some cases, you may be referred to a voice laboratory for special tests (acoustic analysis)

HOW ARE VOCAL DISORDERS TREATED?

1] The treatment depends on the cause. However, most patients can be treated by simple measures – voice rest, steam inhalations, and by maintaining a good fluid intake.

2] Avoidance of smoking, including second-hand smoke, is recommended.

3] Associated conditions e.g. reflux, may also need to be treated.

4] You may require a referral to a speech therapist who  is trained to assist in voice modification, which may eliminate some voice disorders. This can sometimes resolve vocal nodules.

A singing teacher can sometimes be of help.

5] Surgery may be recommended if a discrete lesion, e.g. polyp, is identified. This helps to confirm the diagnosis, as the surgical specimen is sent to a pathologist. It may also improve the quality of the voice.  If cancer is suspected, this will be managed appropriately.

CARE OF THE VOICE

-GIVE UP SMOKING

1] Avoid clearing your throat or coughing- swallow some water instead

2] Avoid yelling and screaming

3] Avoid speaking to large audiences without the aid of a microphone

4] Avoid whispering

5] Avoid using your voice when you have cold or other upper respiratory tract infections

6] Drink more water and less tea/coffee- keep your throat moist – avoid getting a dry throat

7] Turn the radio or TV down to avoid raising your voice to be heard above it

8] Rest your voice after prolonged talking or singing

9] Wave a flag; clap your hands etc at a sports event instead of yelling

10] Move away from noisy machinery or closer to the person you are speaking to in noisy places

11] Relax, keep fit and avoid bottling up your feelings

12] Seek help if you think you have a voice problem.  See your GP and ENT Surgeon, or a Speech Therapist

YOUR CONSULTATION

If you have been hoarse for more than 4 weeks, or have severe hoarseness for more than a few days, or if the hoarseness is associated with pain, coughing up blood, difficulty swallowing, a lump in the neck or difficulty breathing,  you should call 031 201 3118 to arrange an appointment.

A full history of your problem will be taken, and a flexible laryngoscopy will be done (to directly visualise the vocal folds) to make a diagnosis.

Thereafter, and appropriate course of management will be outlined, according to best ENT specialist  practice guidelines.