Hoarseness, also known as dysphonia, is an abnormal change in the quality of your voice. This will make your voice sound raspy, strained, weak, fatigued or higher or lower pitched. The changes in your voice are usually due to disorders of your vocal cords causing a change in sound. If hoarseness persists longer than two weeks, with absence of recent acute upper respiratory infection, you need to have this evaluated by your ENT specialist.
Your ENT specialist will obtain a thorough medical history and perform a complete physical exam which requires passing a small flexible camera (called a fiberoptic endoscope) through your nose and down the back of your throat to view your vocal cords and see how they function.
There are a number of conditions which can cause hoarseness. Acute viral laryngitis is the most common cause of hoarseness. A viral infection in your throat and lungs can cause swelling of your vocal cords. This is usually a self -limiting event, treated with supportive care and voice rest.
Often, acid-reflux can contribute to hoarseness. Acid reflux episodes typically transpire after meals, which is usually correlated with foul tasting regurgitation and heart burn sensation. This occurs because your esophageal sphincters are relaxing (or they may not be closing as well as they should- such as with a hiatal hernia) and allows acid into the esophagus and throat. Sometimes, patients do not experience the typical acid reflux symptoms and they may be diagnosed with “silent reflux”. This is when acid is forced into the throat and leads to atypical reflux symptoms like hoarseness, cough, throat irritation or difficulty swallowing.
Another common cause are non-cancerous vocal cord lesions. These include nodules, polyps and cysts on the vocal cords. These develop after prolonged trauma to the vocal cords from talking too much, too loudly, acid reflux or post nasal drip. Treatment for non-cancerous vocal cord lesions includes practicing proper voicing technique through voice therapy, adequate hydration and sometimes surgery.
Pre-cancerous or cancerous lesions on the vocal cords can also cause hoarseness. The hoarseness will last for several weeks with either no improvement or deterioration of symptoms. Smoking greatly increases your risk of getting throat cancer. Surgery is needed to diagnose and treat pre-cancerous or cancerous lesions. Sometimes, other cancer treatments are needed, such as radiation therapy or chemotherapy.
If you have been diagnosed with a neurological disorder such as Parkinson’s Disease, Myasthenia Gravis, ALS, Multiple Sclerosis, or having suffered from a stroke, you may have a neuromuscular issue with your vocal cords. A rare disorder called spasmodic dysphonia can also create hoarseness, cracking in your voice or uneasy breathing. Vocal cord paralysis can occur after a neck or thyroid surgery, viral illness or injury to the area. When this happens, your voice will become breathy. Sometimes this is transient and will resolve with time. If severe, surgical intervention to reposition the immobile cord will be performed to help improve voice quality and for some swallowing and cough.