What is hoarseness?
Hoarseness is a general term that describes abnormal changes in voice quality. Common changes can include a person’s voice becoming rough, harsh or squeaky or the voice cracking when the person tries to speak loudly or shout. Sometimes the volume or pitch can become too extreme (i.e. too high or low). In some cases, a person may have no voice at all.
Changes in voice quality are usually due to disorders affecting the vocal cords (also known as vocal folds), which are tiny bands located in the voice box. Common disorders that affect vocal cords include nodules, polyps, granuloma, cysts, pseudocysts, vocal fold paralysis, vocal fold paresis, muscle tension dysphonia, puberphonia, cancer of the voice box, vocal fold papilloma, leukoplakia of the vocal folds, hemorrhage, laryngitis and fungal infection of the voice box.
What are the symptoms?
Common symptoms include:
- Raspy or hoarse voice quality
- Difficulty projecting
- Strain while speaking
- Shortness of breath while speaking
- Difficulty singing
- Worsening of voice quality at the end of the day or after increased talking
- Pain and / or discomfort in the throat
- A lump-in-the-throat sensation
- No voice or the inability to speak
- Reduced singing range
- Voice fatigue
When should I see a specialist?
You should make an appointment to see an ear, nose and throat doctor or a speech-language pathologist if you experience the following symptoms:
- Hoarseness lasting longer than two weeks
- Loss or severe change in voice lasting more than a few days
- Difficulty swallowing
- Pain in the throat that is not related to an upper respiratory tract infection
- Lump in the throat
- Coughing up blood
How is hoarseness evaluated?
Hoarseness is evaluated by a multidisciplinary team including an otolaryngologist and a speech-language pathologist with a specialization in voice. Often this type of specialized team is found at a “voice clinic.”
After gathering a comprehensive medical history, the otolaryngologist and/or the speech-language pathologist will take a look at the vocal cord structure and movement with either a rigid endoscope that remains in the mouth or a flexible endoscope that goes through the nose. Evaluation of vocal cord movement is done by performing a stroboscopy or high-speed endoscopy. In addition, other specialized testing is performed to measure voice acoustics and aerodynamics (breath support for the voice).
What is the treatment for hoarseness?
Hoarseness is best managed by a team of professionals who understand and know how the voice works. The professional team involved in care and management of voice disorders includes but is not limited to laryngologists (ear, nose and throat doctors who specializes in the area of voice), speech-language pathologists, singing coaches, voice teachers, acting coaches, psychologists, gastroenterologists and pulmonary specialists.
Depending on the cause, hoarseness can be treated medically, surgically and with voice therapy. The recovery period varies. Some voice conditions can be treated in as little as one hour and some may require long-term ongoing management.