Hoarseness


What is it about ?

The vocal cords are located in the larynx (in the throat). The exhaled air causes the vocal cords to vibrate, and these vibrations produce the sound of the voice. The frequency of the vibrations and the shape of the mouth, lips and tongue allow the production of sound. Disturbances in these vibrations lead to distortion of sounds and hoarseness. Hoarseness can have an organic, neurological or functional cause:

  • organic causes are conditions causing inflammation of the vocal cords (e.g. upper respiratory tract infection or reflux) or anatomical changes such as vocal cord nodules, polyps, cysts and tumors;
  • certain neurological disorders, such as Parkinson disease, affect the nerves or muscles in such a way that the vocal cords can become paralyzed;
  • in the event of functional disorders, a bad use of the voice is in the foreground.

What is its frequency?

Everyone has been hoarse in their life, usually after a throat or respiratory infection. On average, 7 out of 1,000 people see their GP each year for voice problems. Vocal cord tumors usually occur in male smokers between the ages of 50 and 70.

How to recognize it?

The main symptom is an altered sound of the voice (hoarse or hoarse). Sometimes the voice disappears completely or the person cannot form certain sounds. After a period of rest (eg at night), the voice returns to normal, but symptoms may reappear during the day. They can be acute and go away on their own after a few days, but they can just as easily last and become chronic. In addition to voice problems, you often have a fever, sore throat, and a cold if you have an upper respiratory infection. A tumor of the vocal cords can be associated with swallowing problems and coughing up blood. In neurological disorders, the sound power of the voice and the rhythm of speech were impaired. Functional disturbances mainly occur in people who misuse their voice over an extended period of time (eg when teaching or singing, etc.). This leads to voice fatigue.

How is the diagnosis made?

The doctor will first ask you about your symptoms:

  • Do you have a runny nose or fever?
  • Do you smoke ? Do you drink a lot of alcohol?
  • What is your profession (eg professional singer, teacher)?
  • What medications are you taking (eg cortisone)?

He will also check your medical history (eg a procedure with respiratory assistance). With this information, the doctor can already largely know what the most likely cause of your hoarseness is. Then he will examine your mouth, nose and throat. If, however, he finds no cause and the symptoms persist for more than 4 weeks, he will refer you to an ENT doctor for further examinations (including a laryngoscopy). Suspicious lesions are seen by means of a biopsy. The stage of these lesions is then determined by means of a CT scan or an MRI.

What can you do ?

The first measure in case of hoarseness is to leave the voice at rest. Avoid coughing, screaming, singing, clearing your throat, and whispering. Sometimes even a temporary ban on speaking is necessary. Breathe through your nose as much as possible so that the vocal cords dry out less quickly. Drink enough to keep the mucous membranes well moistened. Avoid alcoholic drinks, and spicy or pungent foods that can irritate the throat. Stop smoking and also avoid places with a lot of cigarette smoke. Wear a mouth mask if you are working in a dusty or smoky environment. If you need your voice all the time for your job, incapacity for work of a week or more may be justified.

What can your doctor do?

The doctor usually waits a few days, as the hoarseness usually goes away on its own. In the event of persistent complaints, additional examinations will first be carried out in order to be able to make the correct diagnosis, because the treatment will depend on it.
If the misuse of your voice is causing the hoarseness, he will refer you to a speech therapist for voice therapy.
Occasionally, vocal cord nodules may need to be removed surgically.
Children are sometimes hoarse because they speak too loudly. In this case, the doctor will also test your hearing, as hearing loss is often the cause of this problem.

Want to know more?

Source

Foreign clinical practice guide ‘Hoarseness and dysphonia’ (2000), updated on 19.04.2016 and adapted to the Belgian context on 01.07.2017 – ebpracticenet