Hoarseness or dysphonia are the words we use to describe a change in the way a person’s voice sounds. This can come in various forms. For instance, there may be a strained, breathy or husky quality to the voice. There might also be some change in the pitch of the voice or its volume. It is not uncommon for children to experience changes to their voice as they enter puberty – we commonly refer to this as the voice ‘breaking’. If the voice is lost completely, and the person can only whisper, it is called aphonia.
What is the cause of hoarseness
In normal circumstances, when we speak or sing our vocal cords in the voice box (larynx) come together and vibrate. When this happens, it creates the familiar sound that we recognise as our voice. Hoarseness occurs when those vocal cords are not functioning as they should. There are various causes of this, most of which are not serious and will probably go away by themselves after a short time.
Common causes include:
- Laryngopharyngeal Reflux: stomach acid or enzymes irritating the throat.
- Laryngitis: a viral infection of the upper respiratory tract, resulting in swelling in the lining of the voice box.
- Problems with lung strength can affect the voice.
- An accumulation of polyps or nodules on the vocal cords. This usually occurs when the voice is overused for long periods (singer’s nodules, for example). Polyps on the vocal cords are often associated with smoking.
- Vocal cord paralysis: this affects the movement of the vocal cords and sometimes happens when a vocal cord’s nerve is impacted by a tumour or infection.
- Tumours: it’s very rare, but a benign or malignant tumour can develop on the vocal cords or voice box.
What is the treatment for hoarseness
The fundamental question that governs treatment is whether the hoarseness is consistent or getting worse. It may come and go with intervals of normality in between.
Intermittent hoarseness episodes
These will usually settle by themselves over time. While you wait, you can relieve symptoms by:
- Trying not to talk too much (whispering doesn’t help either)
- Avoiding alcohol and fizzy drinks
- Drinking plenty of water
- Avoiding cigarettes
- Taking antacids to combat reflux where appropriate
Persistent or worsening hoarseness
You should consult your GP if you are experiencing any of the following:
- Hoarseness that persists for 4+ weeks
- Repeated, unexplained spells of hoarseness
- Consistent sore throat or difficulty swallowing for 2+ weeks
It is of particular importance to consult a GP with any of these symptoms if you are a smoker or you regularly drink more than the recommended amount of alcohol. Your GP may decide to make a referral to an ENT surgeon.
What does an ENT surgeon do?
If you are referred to an ENT surgeon, they will perform an examination of the throat to identify what is causing the hoarseness. They will do this by passing a flexible scope through the nasal passage – this is called a Fibreoptic Endoscope. This examination is done as an outpatient so you will not be admitted to hospital at this point.
Depending on the findings of the examination, the ENT surgeon may recommend the following treatments:
This will be for issues with intermittent hoarseness.
Voice therapy with a speech and language therapist
Most patients will have no structural abnormality. The problem will most likely be related to straining the voice in some way. The therapist will be able to advise and possibly recommend exercises to help with hoarseness. It may require more than one appointment with the therapist.
This is an operation to remove polyps, nodules and benign tumours if they are identified by the ENT surgeon. The procedure is usually performed under general anaesthetic with the use of an Endoscope and a microscope. It can remove the piece of tissue that was identified, which will then be sent for a biopsy to determine whether it is cancerous. If cancer of the larynx is diagnosed, further treatment will need to be arranged.
Possible cancer treatment options
This procedure may involve the removal of part or all of the voice box (a partial laryngectomy or a total laryngectomy). It is considered to be major surgery and will involve making an incision through the skin of the neck and may also involve opening the windpipe at the front (known as a tracheostomy).
With some tumours, the surgery can be carried out using an Endoscope through the mouth, with the tumour removal done by a laser. This means you don’t need to have your neck opened. There is a continuing debate surrounding the value of different versions of the surgery – your surgeon will discuss your options with you.
If it is decided that a total laryngectomy is required, there are several ways the patient can be enabled to regain their speech. The most common form is through the insertion of a ‘speaking valve’ through the tracheostomy opening. If you are undergoing this procedure, your surgeon and voice therapist will discuss everything in detail and you will receive training to assist.
In this process, high-energy X-rays are applied to kill cancer that is present on the voice box and/or vocal cords. Radiotherapy is usually provided by a clinical oncologist and typically involves daily treatments. These will be carried out 5 days a week for around 5-6 weeks. Unfortunately, radiotherapy can cause a number of side effects – these will be discussed with you by the surgeon and/or oncologist.
Hoarseness is not uncommon and is usually caused by simple issues that get better by themselves with rest, painkillers and plenty of water. In some rare cases, however, it can be a warning sign that something more serious is going on in the throat. If you are a smoker, you should pay close attention to these symptoms, and if hoarseness persists or gets worse over a period of several weeks then you should see a GP or an ENT Specialist.
The doctor will advise on any available treatments for your hoarseness and will refer you to a specialist if they feel it is necessary.