Hoarseness
Hoarseness is a general term used to describe any voice changes. This may include changes in voice quality (breathy, raspy, or strained), volume (loudness), or pitch (high or low).
Probably the most feared cause of hoarseness is a cancer of the larynx. Smoking and alcohol are major risk factors for cancer. Any smoker who is hoarse should be seen by an otolaryngologist. |
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Most causes of hoarseness are not serious and tend to go away in a short period of time. An example is acute laryngitis which is usually associated with the common cold, upper respiratory tract infection, or vocal abuse (excessive voice use or screaming/yelling).
Other benign causes of hoarseness include postnasal drainage or gastroesophageal reflux disease. Vocal nodules, small callous-like growths on the vocal cords, result from prolonged vocal abuse. Neurological disorders can cause impairment of vocal cord movement and also result in swallowing difficulty. A vocal cord paralysis often results in a breathy voice or a voice that fatigues – stronger at the start of the day and breathy or gone by the end of the day. This can be caused by tumors of the skull base, neck and chest pressing on the nerve that controls vocal cord movement, viral infections, inadvertent injury during surgery, blunt neck or chest trauma, and occasionally from endotracheal intubation.
Some systemic diseases can cause hoarseness such as laryngeal myxedema from hypothyroidism. Medications causing chronic cough (such as angiotensin-converting enzyme inhibitors) can lead to voice changes.
What to expect at your office visit:
The typical examination for hoarseness includes a full head and neck exam as well as visualization of the vocal cords. Sometimes a full view with a hand held mirror in the throat can be obtained but usually a view with a fiberoptic scope is needed. Photodocumentation and the use of stroboscopy (slow motion assessment) is used to help evaluate the condition and motion of the vocal cords. |
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There are two main types of scopes that may be used. One is a flexible fiberoptic scope that is inserted into the nose and gently down into the upper part of the throat. This allows testing of sensation and visualization of the cords during phonation as well as eating. Sometimes you may be asked to ingest food or water colored with a food dye during fiberoptic visualization to assess for any signs of aspiration (food going down into the trachea instead of the esophagus). This exam is called a fiberoptic endoscopic examination of swallowing (FEES).
The other scope is a rigid fiberoptic scope that provides superior resolution and better detailed visualization of the vocal cords and surrounding throat. This scope is held inside the mouth.
