Hoarseness

Diagnosis and treatment of hoarseness should be carefully performed, because hoarseness is a significant indication and it must be investigated if it continues for more than 15 days.  Its cause may be very different starting from a simple upper respiratory tract infection to paralysis of vocal cords and throat cancers.  Hoarseness is observed when we use our voice inaccurately (shouting, crying out loud, etc.), because of vocal cord nodules and cysts, viral infections, paralysis of vocal cords, sinusitis that cause continuous post-nasal drainage, gastric acid coming up to the esophagus and the most important throat cancer.

VOICE DISEASES

Your voice is an instrument that shows who you are to the world in your environment.  It is specific to the individual just like fingerprints.  It gives hints to the other persons especially when  visual communication is not present.

Hoarseness

Hoarseness means abnormal changes in the voice.  Voice can be heard as whispering, cracked, forced; there may be change in its intensity or tone.  Changes in the voice are generally dependent on the disorders related with vocal cords.  Vocal cords are located in larynx.  They vibrate during talking, thus first step of voice formation is realized.  Number of these vibrations change between 200-300/sec in women and 100-150/sec in men.  Vocal cords open during breathing.

Reasons of hoarseness

Voice disorders can be related with problems in the larynx or other organs functioning in the voice formation other than larynx.  It is necessary for vocal cords to get close to each other along their whole length symmetrically for normal voice formation.  Paralysis of vocal cords or large masses that are located on the free edge of the vocal cord cause air leakage and windy voice.

Hoarseness has various reasons.  Most of them do not cause serious health problems and get better in a short period of time.  Common reason of hoarseness is “acute laryngitis”.  Acute laryngitis shows up during other upper respiratory tract infections or when voice is forced by extreme shouting.  In general, voice returns to normal within one or two weeks.

Vocal cord nodules are classically small enlargements on the front 1/3 back 2/3 connection points of vocal cords that are present on both vocal cords at the same time.  These lesions are mostly seen in persons who use their voice extremely or in a bad way.  Nodules are observed more frequently in young women and male children.  Its incidence is more in individuals who talk a lot in a group, perform their profession by their voice in comparison to the other occupational groups.  Nodules that develop when vocal cords strike each other continuously with a force more than normal, do not disappear by themselves unless voice usage habit is improved by means of voice training.  Small bleedings may occur in the vocal cord during acute laryngitis following extreme shouting; is voice is not relaxed in this stage, this bleeding may take the form of unilateral vocal cord swelling called polyps and causes persistent hoarseness.

Reinke edema is one of the reasons of hoarseness continuing for a long time (chronic).  Generally it is related with bad usage of voice, smoking, chronic (continuing for a long time) cough that irritates vocal cords, habit of clearing the throat, and laryngopharyngeal reflux (silent reflux).  Vocal cords are seen like sausages in the video-stroboscopic examination.  That is, it has an appearance of a colored, water-filled sack.  One of the most common reasons of hoarseness in adults, is that acidic fluid in the stomach raises from the esophagus to the level of throat because of weakness of one of the muscles at the point where esophagus and stomach connect; and it irritates the vocal cords; this is called laryngopharyngeal reflux.  Hoarseness is severe especially in the mornings and it reduces within the day.  Tickle in the throat, feeling of there is a foreign matter and frequently clearing the throat are indications that accompany hoarseness.  There are no complaints related with stomach in most of the patients who have hoarseness because of reflux.

Laryngitis

Laryngitis is swelling of vocal cords mostly because of infection.  Most common reason is spreading of a viral infection of upper respiratory tract.  When vocal cords swell, their vibration alters and this causes hoarseness.  The best treatment shall be to relax the vocal cords and to drink plenty of water.  Antibiotics are not effective, since most of these infections develop because of viruses.  It is very important to protect your voice during a laryngitis attack, because swelling of vocal cords may give rise to bleeding resulting from a damage in this region, or formation of nodules, polyps or cysts.

Vocal cord lesions

Benign lesions on the vocal cords that do not have characteristics of cancer, develop because of faulty or inadequate usage of voice, and trauma or damage of the vocal cords.  These lesions impair vibration of vocal cords. This impairment of vibration results in hoarseness and chronic changes in the voice quality. The most common vocal cord lesion is nodules known as “singnodule”.  They are typically located on both vocal cords reciprocally.  These nodules are treated by means of voice resting and talking therapy.  Vocal cord polyps or cysts are other lesions that develop because of faulty or inadequate usage of voice, and they are removed by surgery if non-surgical treatments do not give any result.  Allergy, goiter and nervous system diseases are among the less often reasons of hoarseness.  Hoarseness to a certain degree may be experiences together with natural aging.  Smoking is another reason of hoarseness.  People who have unimproved hoarseness and are smoking should visit a specialist of Ear-Nose-Throat diseases, because smoking is a significant risk factor in the development of throat cancers.  When your hoarseness continues for more than two weeks and there is no specific reason, you should be examined by an ENT specialist.  Problems related with voice should be evaluated and treated ideally by a profession team that is involved in problems and functions related with voice.  ENT specialist, voice and talking pathologist, music-singing-diction masters are in this team.  Voice disorders usually have various and complex characteristics, each specialist in this group may have contribution in the treatment.

Examination of Hoarseness

When you apply for hoarseness, ENT specialist shall listen your complaints and learn your medical history, then he/she will try to see your throat and vocal cords by means of a mirror or endoscope.

Treatment of Hoarseness

Treatment of voice disorders varies according to the reason of hoarseness.  Most of the situations causing hoarseness get better by voice resting and acquiring correct habit of voice usage.  Your ENT specialist can give you information about voice usage, send you to the voice and talking pathologist for training or if there is a visible reason such as polyps, may suggest surgery.  It is requested from all patients with voice problem, especially those who shall have a surgery, not to smoke and to avoid environments under cigarette smoke, and to drink plenty of water.  Voice and talking pathologists try to teach correct technique of using the voice, and to eliminate the faulty technique if any.  In some patients, the problem is negative habits in terms of voice usage such as smoking and shouting.  In this case, technique of the patient is improved and if any, nodules are treated.

What can be done to prevent hoarseness?

• Quit smoking.
• Avoid usage of caffeine (coffee, beverages with cola, etc.) and alcohol.
• Avoid environments under cigarette smoke.
• Drink plenty of water.
• Humidify air of your house.
• Be careful about your foods, avoid spicy food.
• Do not use your voice for a long time and at a high intensity.
• Relax your voice when you have hoarseness.
• Paralysis of Vocal Cords

Paralysis of vocal cords may occur because of head and neck injuries, tumors, diseases, surgeries or palsies.  Damage of Nervus Vagus (Tenth Cranial Nerve) of which, its branches reaches till larynx (throat) from brain stem and which control the movement of vocal cords; is the basic reason of paralysis of vocal cords.  Degree of voice and swallowing problems changes according to the level of the damage on the nerve.  The most typical symptoms are as follows:

• Hoarseness
• Air in the voice
• To lose ability of talking loudly
• Restriction of alteration in tone and loudness of voice
• Shortening of the time period to extend and continue the sound made (about 1 second)
• Risk of drowning and/or coughing during eating
• Probability of pneumonia that may develop because of food and drinks escaping to lungs and being aspirated (because vocal cords can not exactly and sufficiently close during swallowing to protect lungs).

Muscle-nerve transplantation, medialization thryoplasty (operation to approximate paralyzed vocal cord to the mid-point) or injecting an agent to the vocal cord to increase width of paralyzed vocal cord are among the medical treatment methods.  Behavioral therapy methods consist of voice therapy techniques to be given by Talking and Language Pathologist, and this method may be the only treatment option to be recommended for the patient.  In this case, individual is exercised with the help of the Talking and Language Pathologist to change his/her voice tone, to increase breathing support and loudness of the voice, and to find the best position for the formation of sound (for example: to turn the head towards to one side or to manipulate thyroid cartilage).