Hoarseness

What is Hoarseness?

All changes in normal voice quality are generally defined as hoarseness. Different symptoms occur with different pathologies, such as air leakage between the vocal cords during speaking, change in the voice frequency, and intermittent interruptions of the voice.

What are the Most Important Factors that Trigger Hoarseness?

The formation of the voice begins when the air from the lungs passes through the vocal cords. The vocal cords that get close to each other by means of the function of the throat (larynx) muscles and mucosa passively vibrate with the effect of the air pressure. These vibration occurs on the superficial tissue (the mucosa covering the vocal cords and the loose tissue just beneath the mucosa), creating a mucosal wave from the midline to the sides. The voice that occurs at level of the vocal cords take its final form after shaped in the resonance chamber consisting of the throat, nasal passages, sinuses and oral cavity.

Voice disorders may occur due to problems in the organs other than the throat, which function for normal voice formation.

Normal voice formation requires the vocal cords to get close to each other symmetrically throughout their lengths. Vocal cord paralysis or masses located at the free edges of the vocal cords lead to air leakage and whispering voice.

The surface of the inner free edges of the vocal cords that vibrate for normal functions of the vocal cords, should be smooth. Pathologies such as polyps, nodules or superficial disorders in this region impair the voice character.

Certain conditions such as inflammation of the vocal cords (laryngitis) that lead to swelling (edema) of the vocal cord mucosa, infections in the throat and sinuses, smoking, stomach acid reflux, improper use of the voice and overtaxing the vocal cords cause hoarseness. Overtaxing the vocal cords may create bleeding in the mucosa and consequently sudden hoarseness.

In addition, voice is also affected by pathologies at any point of the resonator chamber, where the voice is shaped. Voice changes that occur during nasal congestion are referred to as hyponasal speech; and the voice that occur during diseases in which the nasal passage expands are referred to as hypernasal speech.

Masses in the rear and lower part of the throat cause a characteristic voice change called "hot potato voice".

When the anatomy is normal, voice disorders may occur due to abnormal functioning of the throat muscles.

How is Hoarseness Diagnosed?

In the diagnosis of hoarseness, first a detailed story should be taken. Knowing certain details, such as about whether the problem occurs continuously or intermittently, whether it becomes more evident in the morning or evening, as well as about smoking and overtaxing the vocal cords voice are helpful in diagnosis.

The exact diagnosis is made with the examination of the vocal cords. Larynx mirrors, hard endoscopic systems or bendable endoscopes allowing for examination through the nose are used for examination. 

Patients, whose condition cannot be diagnosed by this way can be examined with laryngostroboscopy for the evaluation of the vibration of the vocal cords and with microscope under operating room conditions, for detailed examination of the vocal cords. 

Hoarseness is more important in patients who smoke since it can be a warning sign of tumors or diseases originating from the vocal cords that have a potential to turn into tumor. In this cases laryngeal examination should be done without delay if the symptoms does not begin to decline within 4 to 5 days.

Are There Diseases that Develop in Association with Hoarseness?

In patients, whose hoarseness is caused by vocal cord paralysis, this can lead to diseases that occur due to insufficient closing of the larynx during swallowing and food or saliva leakage into the lungs.

Vocal cord paralysis or masses narrowing this region may also cause respiratory insufficiency and associated limitation of effort capacity, hypertension, heart failure, and even asphyxia.

What are the Treatment of Hoarseness and the Ways to be Protected from It?

Treatment should be administered based on the cause. Almost all treatments involve reducing the use of voice (or a complete voice rest for a certain period of time), definitely quitting smoking, increasing the daily fluid (especially lukewarm water) intake, and reducing gastric acid secretion. In pathologies other than tumoral diseases, "low-power laser therapy" has recently begun to be used more commonly with each passing day; and successful results are achieved especially for shortening the healing process.

Antibiotics and edema reducing medications are used in the treatment of vocal cord inflammation.

Primarily voice training is recommended for vocal cord nodules, whereas surgical procedures are required for polyps and tumoral diseases. 

In the treatment of certain malignant diseases, radiation treatment can be preferred instead of surgery in early periods.

In vocal cord paralyses, surgical operations intended for approximating the vocal cord (which remained motionless in at the side) to the midline; or various injections can be given to the free edge.

For patients diagnosed with stomach acid reflux, gastroenterological examination is required.

Certain methods such as speech therapies and botulinum toxin injections are used for the treatment of voice disorders that occur due to hyperfunction of the vocal cord muscles.

When to see a doctor?

In case of hoarseness of unknown origin, particularly patients who smoke should consult an ENT specialist as soon as possible. If recovery does not begin within 4 to 5 days in cases of hoarseness developing after excessive shouting or during respiratory system infections, it would be appropriate to get examined.

What are the Points to Take into Consideration About Hoarseness?

The most important factors adversely affecting the vocal cords include mucosal dryness, tobacco smoke, gastric acid reflux and excessive use of the voice by pushing its limits. 

Therefore, abstaining from smoking, drinking plenty of water, abstaining from lying down when the gastric acid is at high levels (for 2 to 3 hours after eating), preventing air dryness especially in the bedroom, solving problems that adversely affect the vocal cords such as nasal congestion and sinusitis and abstaining from speaking loudly and for extended periods of time will generally reduce the risk of hoarseness.

Since hoarseness can be a warning sign of important diseases, patients need to get examined by an otolaryngologist if their complaints about voice do not begin to settle down within 4 to 5 days.