OakLeaf Medical Network Healthy Viewpoints, Winter 2003
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Michelle Facer, DO

Losing your voice. Common causes of hoarseness.

Michelle Facer, DO
Northern Pines Ear, Nose & Throat
Eau Claire

During the Wisconsin winter months, many people contract colds; some develop hoarseness. Often, people will state they have laryngitis. Laryngitis is an infection or inflammation of the larynx (voice box), while hoarseness describes a change in the voice. Vocal quality may sound breathy or forced or there may be a decrease in volume or pitch. These changes are usually due to disorders of the vocal cords (the voice box or larynx). The vocal cords are like a miniature instrument and function by opening to breathe and by closing to vibrate and create sound when speaking.

Laryngitis in Adults

The most common cause of hoarseness is laryngitis. Adult laryngitis is usually due to viral upper respiratory tract infections (colds), smoking, gastroesophageal reflux disease (GERD) or vocal misuse such as excessive shouting. Most cases of viral laryngitis resolve within two weeks. GERD is caused by stomach acid coming up the esophagus and irritating the vocal cords. Usually, the voice is worse in the morning and improves throughout the day. Some people have a sensation of a lump in the throat, feel thick mucus in the throat, or the need to frequently clear the throat. Treatment is aimed at changing diet and lifestyle habits such as stopping smoking, avoiding caffeine and spicy foods, and not eating within three hours of bedtime. Sometimes, medications to reduce stomach acid are needed and occasionally surgery is recommended.

Laryngitis in Children

In children, laryngitis is frequently associated with viral infections. It can be more serious in children due to the smaller size of their airway. During the fall and winter, croup is common. Most children run a temperature followed by the development of a characteristic barky cough several days later. The cough is nonproductive and tends to worsen at night. In most cases, croup is self-limited. However, if significant difficulty breathing develops, immediate medical attention must be sought and further treatment undertaken. Sometimes, severe infections can occur. Symptoms consisting of a rapid onset of fever, sore throat, and noisy breathing (stridor) require immediate medical attention.

Other Causes of Hoarseness

Hoarseness that persists beyond several weeks can be due to vocal cord nodules, cysts, or polyps; all of which are benign. Nodules are common in singers and in adults and children who frequently shout or raise their voices. Diagnosis requires evaluation by an Otolaryngologist (Ear, Nose & Throat Surgeon-ENT). Most problems will resolve with conservative therapy such as vocal rest or speech therapy, but occasionally surgery is needed.

Hoarseness can also be caused by malignant growths on the vocal cords. Other associated symptoms include difficulty swallowing, a persistent sore throat, ear pain, a lump in the neck, and coughing up blood. Cancer of the vocal cords tends to present at an early stage and is readily treatable in the majority of cases, if intervention is sought early.

In some cases, hoarseness can be caused by a failure of one or both vocal cords to move properly. This is known as vocal cord paresis (weakness) or paralysis (inability to move). There are a variety of causes of vocal cord paralysis depending on whether the patient is an adult or child. Causes include cancer, trauma, prior surgery, neurologic disease, infections and unknown causes. A thorough evaluation must be undertaken to determine the cause and to provide appropriate treatment.

Less common causes of hoarseness include allergies, thyroid problems, the normal menstrual cycle and other unusual diseases including amyloidosis, sarcoidosis and Wegener’s granulomatosis. If hoarseness persists beyond two weeks, especially in a patient who smokes, evaluation by an ENT physician is recommended. The diagnosis can often be made during an office visit after a thorough history and a complete exam of the larynx with either a mirror or a fiberoptic scope. Depending on the diagnosis, therapy can then be initiated with the hope of restoring the voice to normal.

How to prevent and treat mild hoarseness:

  • Quit smoking
  • Drink lots of water
  • Use a humidifier in the winter
  • Avoid shouting
  • Avoid caffeine
  • Do not force the voice or whisper
  • If you sing, seek professional voice training

For more information or to schedule an appointment with Dr. Michelle Facer, DO, Northern Pines Ear, Nose & Throat, Eau Claire, Otolaryngologist, call 715.831.3300.