Voice changes are caused when there is an abnormality of the vocal cords in the voice box (larynx). The vocal cords open when we breathe and come together and vibrate when we speak, producing sound. In order to produce a normal healthy voice, the vocal cords are smooth. Any abnormality on the surface of the vocal cords will cause them to vibrate improperly, altering voice quality. Abnormalities of the voice are referred to as hoarseness. Hoarseness may refer to changes in the volume or pitch of the voice, and the voice may sound strained, raspy, or breathy. The board certified physicians at Coastal Ear, Nose and Throat are specialists who can evaluate and treat disorders of the larynx.

 

Acute Laryngitis- The most common cause of hoarseness is swelling of the vocal cords during an upper respiratory infection or due to voice strain. 

Voice Misuse- Examples of misuse include excessive use of the voice, speaking in noisy situations, using inappropriate pitch when speaking, speaking in noisy situations without amplification, and singing without proper vocal hygiene.

Reflux- Reflux may cause hoarseness with or without typical heartburn symptoms. When stomach acid reaches the voice box it is referred to as laryngopharyngeal reflux (LPR). Acid and digestive enzymes irritate the larynx and cause hoarseness, often accompanied by a sensation of a lump in the throat.

Benign Lesions of the Larynx- Cysts, polyps, and nodules can cause hoarseness. Nodules (calluses of the vocal cords) are due to voice misuse, but polyps and cysts may form for other reasons.

Smoking- Smoking can produce a variety of changes to the voice box, including larynx cancer. Smokers with persistent hoarseness should be evaluated by an Ear, Nose and Throat physician.

Neurological Disorders- Hoarseness may be part of Parkinson’s Disease or due to a stroke. It can also be due to a neurological problem affecting only the voice, such as paralysis of a nerve to the voice box creating a breathy voice or spasmodic dysphonia, a type of vocal tic affecting only the voice box. 

Head and Neck Cancer-A rare but serious disorder which requires immediate evaluation and treatment by an Ear, Nose and Throat physician

Other causes-Allergies, infections, and other conditions can affect the voice box.

 

A complete history and examination of the head and neck are usually necessary to evaluate hoarseness. This includes examination of the vocal cords. This is usually accomplished by anesthetizing the nose ad examining the voice box using a very small fiber optic scope through the nose and looking directly at the vocal cords. The procedure takes two minutes and is not associated with significant discomfort or complications. Hoarseness lasting more than three weeks should be evaluated by a specialist. If a serious problem is suspected, then immediate evaluation is necessary. 

 

The treatment of hoarseness is determined by diagnosing the cause of the problem. Once the cause is diagnosed, your physician may recommend  speech therapy, medications, or microsurgery in order to treat the cause. Your physician at Coastal Ear, Nose and Throat will explain the cause of your hoarseness and treatment options.