Hoarseness - Associated Disorders, Symptoms, Diagnosis, and Management

Introduction

Vocal cords are present above the trachea (windpipe). The vocal cords are surrounded by two bands of muscles called vocal folds. Normally these vocal folds remain closed while breathing and swallowing. When we speak, air from the lungs passes through and makes these vocal folds vibrate, forming sound waves of the voice.

What Are the Diseases That Cause Hoarseness of Voice?

Various causes of hoarseness of voice are:

• Sinusitis: Sinus infection or cold or flu for a long time or postnasal drainage in the throat during sinusitis can cause hoarseness.

• Laryngitis: It occurs due to swelling of the vocal folds due to overuse of vocal cords or infections.

• Overuse of Voice: Excessive use of voice like screaming, shouting, or yelling also leads to a hoarse voice.

• Infections: Bacterial and viral infections like strep throat can affect the throat and can cause hoarseness.

• Acid Reflux: Gastrointestinal reflux disease causes the formation of excess acids in the stomach, which go into the throat resulting in hoarseness.

• Systemic Diseases: In case of thyroid disorder (thyroid cancer or lump in the throat like goiter can cause damage to vocal cords) and acromegaly (thickening of vocal cords compresses the nerves to vocal cords).

• Vocal Cord Paralysis: It occurs due to disturbance in nerve impulse transmission to the vocal folds due to various factors like:

1. Vocal Cord Damage: Damage to vocal folds during surgeries like thyroid, parathyroid, or neck cancer surgery.
2. Swelling or Lump in the Neck: Cancerous or noncancerous growths in the neck causing compression of the nerves to the voice box.
3. Neuromuscular Diseases: Nerve and muscle disorder causing weakness of vocal fold muscles like multiple sclerosis or Parkinson’s disease.
4. Bacterial/Viral Infections: Infections involving the nerves to the vocal cord.

• Vocal Cord Hemorrhage: It occurs due to rupture of blood vessels within the vocal fold causing pooling of blood in between the vocal folds resulting in disruption of voice.

• Nodes in Vocal Cords: The presence of nodules in the vocal cords, also known as “Singers nodes” (Mostly seen in singers), causes disturbance in the voice because of the pressure of the nodular growth on the vocal fold.

• Cyst Involving Vocal Cords: The formation of cysts in the vocal folds also disrupts the voice.

• Spasmodic Dysphonia: It can occur due to tightening of the muscles of vocal folds leading to strained voice.

• Vocal Cord Polyps: Small growth or blisters formed on the vocal folds during extreme use of voice.

• Scarring of Vocal Folds: Scratch or injury to the vocal cords can occur in a person while surgery during the placement (intubation) or removal of the breathing tubes (extubation).

What Are the Signs and Symptoms of Hoarseness of Voice?

• Reduce or loss of vocal pitch.

• Loss of vocal tone.

• Breathing difficulties.

• Strained or raspy voice.

• Fatigue while speaking.

• Pain and discomfort while talking.

• A complete change in voice due to hoarseness for more than two weeks.

What Are the Diagnostic Methods for Hoarseness?

• Clinical Examination and Medical history: Complete physical examination is done, and medical history like previous neck surgery or radiotherapy for neck cancer is recorded by the doctor to rule out the appropriate underlying cause for the hoarseness of voice.

• Laryngoscopy: A thin instrument with a light attached is used to check vocal cords for any abnormalities like cancerous or noncancerous growth of the vocal fold.

• Computed Tomography (CT) Scan: It is done to check for any cancerous lesions of the vocal folds. It is not recommended to do Computed Tomography (CT) scan or other imaging techniques without checking the larynx by laryngoscopy in case of primary hoarseness.

• Electromyography: It is done to evaluate the electrical impulse transmission by vocal folds in case of vocal cord paralysis.

• Voice Assessment: Assessment of any abnormal changes in the voice is done by the speech pathologist.

How Can We Treat Hoarseness of Voice?

The treatment plan for dysphonia is done by an ENT specialist based on the underlying cause of hoarseness. Various treatment modalities are:

• Relax Your Vocal Folds: Avoid screaming, shouting, and overusing your voice.

• Eliminate the Trigger Factors: Trigger factors like acid reflux should be managed using antacids or proton pump inhibitor drugs.

• Remove the Underlying Cause: Consult your doctor and start medications for any bacterial or viral infections causing voice changes.

• Botulinum Toxin: Botulinum toxin injections are used to treat hoarseness caused by spasmodic dysphonia.

• Neurological Disorder Treatment: Treatment of any underlying nerve disorder like Parkinson’s disease should be done after consulting neurosurgeons.

• Surgery: Surgery is done in cases of cancerous or noncancerous growth present on vocal folds to release the pressure of the tissue growth compressing the nerves.

Any abnormal change in the voice that persists for more than two weeks should be reported to the doctor immediately.

How Can We Prevent Hoarseness of Voice?

Hoarseness of voice can be prevented by:

• Avoid smoking.

• Drink plenty of fluids.

• Avoid overuse of voices like screaming and shouting.

• Avoid excess alcohol and caffeine drinks as it dehydrates the body.

• Avoid spicy foods.

• Avoid trigger factors like smoke, dust, excess cold fluids, and acid reflux that can result in a change in voice.

What Is the Current Research Ongoing to Treat Hoarseness of Voice?

Multiple research is ongoing to develop a “voice dosimeter” that can measure the frequency and dose of voice that is used in a day so that the maximum daily recommended dose of vocal use can be identified.

Some research is also ongoing to identify the normal bacterial flora and gene mapping of the larynx (voicebox) so that any abnormal changes in the bacterial flora resulting in changes in the vocal cords can be identified.

Conclusion:

Hoarseness is very common and not a serious problem. It can affect anyone. Clear and sound speech is important for communication. Any abnormalities in the voice, like hoarseness, can be very distressing and also disturbs the quality of life. As many disorders are associated with hoarseness of voice, accurate diagnosis and early treatment are very crucial. Any abnormal variation in the voice like gasping, straining, or reduced pitch of voice should be noticed and informed to an ENT specialist to evaluate the underlying cause and plan the treatment appropriately.