Hoarseness, also known as dysphonia, refers to having an abnormal voice. It is a common condition that you often experience when you have a dry, scratchy or irritated throat.
Speech distinguishes humans from other creatures. Speech is one of the last skills acquired by a growing child - it is a complex process and requires coordination from many different centers. Your voice (the sound produced by human beings) can get slurry, rough or hoarse due to various reasons, and thus, sound altered or modified at times. If your voice is hoarse, you may have a weak or airy quality to your voice that prevents you from producing smooth vocal sounds. There may be voice breaks where the voice completely stops or cuts out.
In this article, we will understand the causes, diagnosis, treatment, and prevention of hoarseness of voice. Before that, let us look at how your voice is produced.
How Does Your Voice Work?
Voice refers to the sound you produce to communicate meaning, ideas, opinions, etc. Mechanically, the production of your voice involves complex fluid-structure interaction.
Your vocal folds (vocal cords) are attached within the larynx, commonly called the voice box, which is an organ in the top of the neck, primarily involved in breathing, and producing sounds. The larynx is the passage to your lungs and the “thyroid cartilage” or "Adam's apple", is the largest and the uppermost cartilage (smooth elastic tissue, rubber-like padding that covers and protects the ends of long bones).
The vocal folds produce sound when they come together and then vibrate as air passes through them during the exhalation of air from your lungs. This vibration produces the sound wave for your voice. Your lungs are a pair of spongy organs, which form the center of the respiratory system and is responsible for your breathing, i.e., inhalation (breathing in oxygen) and exhalation (breathing out carbon dioxide).
In order for your voice to be clear, and not hoarse, the vocal folds must vibrate together symmetrically and regularly. The rate of vibration determines the pitch (quality of a sound governed by the rate of vibrations producing it) of your voice. When the voice is hoarse, the vocal folds may not be closing fully, or may not be vibrating symmetrically.
Causes of Hoarseness of Voice
Hoarseness is primarily caused when there is an issue with your vocal cords and may involve an inflamed larynx (voice box). This is known as laryngitis. Other common causes are:
1. Chronic misuse: Using the voice excessively, shouting, yelling or excessive crying can cause hoarseness. Apart from people who yell and shout this can occur in teachers (in fact the swellings on the vocal cord are called 'Teacher's Nodules'), politicians, auctioneers at vegetable vendors (sabzi mandi), etc.
When your voice is being used excessively or you are yelling or shouting continuously, day after day, you are not allowing your vocal cord flaps to heal and thus hoarseness stays for long periods of time.
2. Lifestyle issues: Smoking, consuming excessive alcohol with ice, eating chilly and spicy foods can cause your vocal cords to become inflamed and cause hoarseness.
Excessive smoking can irritate and dry out your vocal cords, resulting in inflammation on the vocal cords.
Alcohol also has a similar effect. It dry outs the mucous membranes (tiny hair-like structures that provide lubrication to your voice box) lining your larynx, thus causing hoarseness.
3. Benign (not cancerous/ harmful) swellings of your vocal cords:
- Vocal cord nodules: Small calluses on the vocal cords from overuse of the voice or vocal cord injury that occurs with yelling.
Vocal cord polyps: Small growth on the vocal cord that is like a blister from overuse of the voice or vocal cord injury during yelling.
Vocal cord cyst: Small growth on the vocal cord that is typically filled with mucous (a slippery, stringy fluid) and causes a rough voice.
Vocal cord hematoma: Hematoma is generally defined as a collection of blood outside of blood vessels. A vocal cord hematoma is a collection of blood within the vocal fold that occurs after the rupture of blood capillaries.
These will need to be surgically removed.
4. Acidity and reflux: On lying down at night, acid from your stomach can travel to the throat and inflame the posterior (back portion) of the vocal cords to cause hoarseness. That is why it is recommended that you take your last meal of the day at least 3 hours before you go to sleep to prevent acid reflux from a full stomach.
5. Neurological problems: Sometimes a vocal cord can get paralyzed and this creates a phonatory gap (when there is a gap at the rare ends of your vocal folds) which causes the voice to become weak and breathy.
6. Cancer: Cancer of the larynx (vocal cords), also known as laryngeal cancer is a disease in which malignant (cancer) cells form in the tissues of your larynx. It is a fairly common illness, and in case of persistent hoarseness, you must always have yourself checked by your ENT specialist to rule out a malignant swelling.
While hoarseness of voice itself is a symptom of the above causes, a few other associated symptoms that can occur along hoarseness include:
Difficulty in swallowing
Shortness of breath
If you have hoarseness for more than a week and you have difficulty either speaking properly along with difficulty swallowing, consult your doctor immediately.
Diagnosis of Hoarseness
Your doctor will ask you questions about your symptoms, and general health. Your doctor will try to figure out if:
a) Have you been smoking or drinking alcohol for prolonged periods of time?
b) Do you have a job or profession that requires you to talk continuously?
c) Have you been lately shouting or speaking loudly?
d) Are you on any medications? This is because some medications like ACE (Angiotensin-converting enzyme) inhibitors, antihistamines, antipsychotics can cause dysphonia.
Depending on your answers and severity of symptoms, your doctor might recommend special tests to evaluate voice irregularities or vocal airflow.
Your doctor is likely to examine your throat with a light and tiny mirror to look for any inflammation or abnormalities.
You may be asked to do a couple of X-rays of your throat, CT (computerized tomography) scan, or a laryngoscopy (a procedure in which an instrument called laryngoscope) is used to identify any abnormalities present in the larynx and the vocal cords.
Management of Hoarseness
Your doctor may prescribe medications based on your symptoms/conditions.
Certain self-care measures are suggested for the treatment of hoarseness such as:
Take rest and avoid talking and shouting. Don’t whisper, as this actually strains your vocal cords even more.
Stay hydrated to keep your throat moist and to prevent dryness. Drink plenty of water and other hydrating and warm fluids.
Cut out your caffeine and alcohol intake.
Use a humidifier to add moisture to the air at home. It can help open your airways, prevent dryness and ease your breathing.
Steam inhalation will provide moisture to your throat. You can simply turn on a hot shower and sit in the bathroom for 5 minutes to inhale the steam.
Avoid or limit your smoking to prevent dryness and irritation of your throat.
Suck on over-the-counter (OTC) lozenges to soothe your throat.
Don’t use decongestants or nasal sprays for your hoarseness. They can further irritate and dry out the throat.
Wash your hands frequently. Hoarseness is also caused due to a viral respiratory tract infection. Washing your hands will help prevent the spread of germs and keep you healthy.
While hoarseness in voice is common and disappears on its own, if you have hoarseness continuously for more than a week, then it is advisable to meet your ENT specialist.
Disclaimer: This article is written by the Practitioner for informational and educational purposes only. The content presented on this page should not be considered as a substitute for medical expertise. Please "DO NOT SELF-MEDICATE" and seek professional help regarding any health conditions or concerns. Practo will not be responsible for any act or omission arising from the interpretation of the content present on this page.