Hoarseness: causes and treatment
Hoarseness that does not clear up within 3 weeks needs an examination of the voice box, even if it does not hurt. The check is done at the practice with laryngoscopy and stroboscopy, takes a few minutes and shows whether the vocal cords are damaged or simply working the wrong way.
What is hoarseness?
Hoarseness, often described as a raspy, croaky or husky voice, is any change in the quality of your voice: it becomes rough, weak, breathy or keeps breaking. The medical term is dysphonia. It is not a disease but a symptom, so the job of the examination is to find out what is causing it.
Your voice is produced by the vibration of the vocal cords inside the voice box (larynx). Anything that changes their shape, mass or movement, even slightly, is heard in the voice straight away. That is why hoarseness often appears before any other symptom.
What can cause it?
- Laryngitis, usually after a cold or another upper respiratory infection, is the most common cause and clears up on its own
- Overusing or misusing your voice, especially if you speak or sing for a living
- Nodules, polyps or cysts on the vocal cords, from long-term strain
- Silent reflux (laryngopharyngeal reflux), when stomach fluid reaches the voice box and irritates it
- Weakness or paralysis of a vocal cord, which can appear after a viral infection or after surgery on the thyroid or chest
- Functional voice disorder, where the vocal cords are healthy but the way the voice is produced has gone wrong
- Smoking and chronic irritation, which cause swelling of the vocal cords
- Precancerous changes or cancer of the voice box, less often, which in the early stages show up exactly like this, as painless hoarseness
This last point is the reason why a time limit of a few weeks is not an overreaction.
When should you get it checked?
Our rule at the practice is 3 weeks: hoarseness that lasts longer needs an examination of the voice box, whether or not it bothers you. International guidelines set 4 weeks as the upper limit, meaning no patient should wait longer than that before their voice box is examined. We do not wait even that long.
It should be checked sooner if any of the following is also present:
- Pain that persists, or pain when you speak and swallow
- Δυσκολία στην κατάποση ή στην αναπνοή
- A lump you can feel in your neck
- Blood in your phlegm
- A history of smoking
- Complete loss of voice for several days
For people who use their voice professionally there is no waiting period, because every day the voice keeps being pushed makes the picture worse.
What happens at the appointment?
The appointment starts with your history: when your voice changed, whether you had a cold or strained your voice beforehand, how you use your voice at work and what makes it worse. This is followed by a physical examination of the mouth and neck.
Laryngoscopy (throat endoscopy)
This is done with a thin, flexible endoscope through the nose or mouth, at the practice, with no preparation needed. The image is shown magnified on a screen and shows the vocal cords and the structures around them. It takes a few minutes and does not hurt.
Stroboscopy
This is where the difference lies. A standard endoscopy shows whether there is visible damage. Stroboscopy shows the vocal cords in slow motion as they vibrate, so it shows whether they vibrate evenly and whether they close fully. Many voice problems have no visible damage at all and can only be explained with this examination.
We discuss the findings with you right afterwards, with the images in front of you.
Treatment
Treatment depends on the cause, and in most cases it does not involve surgery.
Non-surgical treatment
- Voice therapy with a speech therapist, when the problem is functional or caused by strain
- Changes to the way you use your voice at work
- Treatment of silent reflux
- Stopping smoking, staying well hydrated, avoiding dry air
- Monitoring with follow-up checks, where the findings allow it
Surgery
When there is damage that does not go away, surgery is done by microlaryngoscopy, meaning microsurgery on the voice box through the mouth, under general anesthesia and without any external cut. The aim is to remove the lesion while preserving the vibrating lining of the vocal cord, because the quality of the voice depends on it. For vocal cord paralysis, there are injection techniques that help the vocal cords close fully again.
Frequently asked questions
After a cold or vocal strain, the voice usually recovers within a few days to 2 weeks.
When it lasts longer than 3 weeks, when it occurs in a smoker, or when it comes with pain, difficulty swallowing or a lump you can feel in your neck.
No. It is done with a thin endoscope through the nose or mouth, with or without a local anesthetic spray, and takes a few minutes.
Not as a rule. International guidelines advise against giving antibiotics for voice problems without first examining the voice box and making a clear diagnosis.
No. Most cases are treated with voice therapy or by treating the underlying cause.
Resting your voice without whispering, staying well hydrated, avoiding smoke and dry air, and treating reflux if present.
If you rely on your voice for work
We don't wait for the time limit
Teachers, singers, actors, church cantors
The check is done earlier and with different criteria, and your vocal range is recorded so that any future change can be seen in measurements.
Medical review: Dr. Ioannis KotrotsosENT Surgeon and Specialist in Phoniatrics and Pediatric Audiology.
Πηγή: Stachler RJ et al., Clinical Practice Guideline: Hoarseness (Dysphonia) — Update, AAO-HNSF, 2018.
The information on this page is for general information only and does not replace a medical examination. For diagnosis and treatment, please consult a doctor.
