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    Hoarseness Can Be More Than a Temporary Nuisance

Hoarseness Can Be More Than a Temporary Nuisance

December 10, 2010

Dear Mayo Clinic:

I've had a hoarse sounding voice for a few weeks. My husband thinks it could be more than just a cold and I should be seen by my doctor, but isn't what I'm experiencing normal for this time of year?

Nearly everyone has experienced hoarseness, whether the result of a nasty cold or too much cheering at a sports event. Usually, the problem goes away after several days with self-care and by resting your voice.

However, hoarseness can be more than a temporary nuisance. I recommend that anyone experiencing hoarseness who hasn't gotten better after two weeks should see a doctor. Hoarseness can result from numerous treatable problems. It also may be a sign of certain forms of cancer, and catching it early improves the odds of successful treatment.

Your speaking voice is formed when air from your lungs is pushed out through the vocal cords in your voice box (larynx). The vocal cords consist of two folds of mucous membrane that cover muscle within a framework of cartilage. As air passes over the vocal cords, they vibrate, producing sound and allowing you to speak.

Swelling and inflammation of the vocal cords — called laryngitis — is a common cause of hoarseness. Fortunately, most laryngitis is acute, meaning it comes on quickly and usually clears up in a few days to two weeks. Laryngitis is most often associated with a viral respiratory infection — such as a cold — or extended periods of yelling, talking or singing. Simple self-care tips that may help include drinking plenty of liquids, sucking on lozenges or hard candy, and resting your voice.

When hoarseness lasts more than two weeks, the list of potential causes grows much larger. Diagnosing a cause begins with a review of your history including potential triggering factors, your occupation, hobbies and other medical problems. The sound of your voice can offer important clues. Different problems may cause your voice to change in different ways, including sounding coarse and scratchy, breathy, strained, weak, wet, whisper-like or having a tremor.

A visual inspection of your vocal cords may be done using either a light and a tiny mirror, or a small camera attached to a thin, flexible tube. The vocal cords are examined to look for any sores, rough patches or nodules.

Treatment strategies for hoarseness typically depend on the cause. Causes include:

  • Repeated irritation of your vocal cords — Sources of irritation include smoking, repeated voice overuse, allergies, corticosteroid inhalers used to treat asthma and chronic obstructive pulmonary disease (COPD), frequent heartburn (gastroesophageal reflux disease, or GERD), excessive alcohol use, or chronic coughing. Ongoing irritation can cause sores on the vocal cord (contact ulcers), small vocal cord swellings (polyps) or callus-like patches (nodules) on the vocal cords.

    Treatment often begins by addressing the likely source of irritation. Nodules, polyps and contact ulcers often heal with elimination of irritants. Voice therapy with a speech lanugage pathologist may also be helpful. Surgery may be needed to remove a polyp or nodule that doesn't go away with more conservative care.

  • Aging of tissues — Vocal cords can lose some tension and fullness with aging. Depending on the degree to which this impairs your ability to talk, consideration may be given to a surgical procedure in which an injected substance can add bulk and fullness to your vocal cords.
  • Cancer of the larynx — Risk factors for this cancer include age over 60, smoking and consuming excessive amounts of alcohol. Detected early, vocal cord cancer can often be successfully treated with surgery or radiation.
  • Complications of another problem — Hoarseness can be caused by many underlying diseases, including rheumatoid arthritis, hypothyroidism, Parkinson's disease, stroke and multiple sclerosis. Damage to voice box nerves can cause hoarseness and occur as a complication of different types of surgery involving the neck, such as thyroid gland surgery.

    When possible, treatment of an underlying cause may improve hoarseness. If there's nerve damage, injected bulking agents can provide temporary vocal cord support if nerves are expected to recover. If nerves aren't expected to recover, surgery may be done to realign vocal cords, or injected agents can be used to form more permanent, artificial vocal cords.

  • Spasm of a vocal cord muscle — This causes undue tension on part of your vocal cord. It usually occurs intermittently. The problem can often be successfully treated with an injection of botulinum toxin (Botox) that paralyzes the muscle in spasm. Symptom relief usually lasts for three to six months, after which a repeat injection will be needed.

Because your hoarseness has lasted for more than two weeks, I recommend that you see your doctor for an evaluation.

— Dale Ekbom, M.D., Otorhinolaryngology, Mayo Clinic, Rochester, Minn.

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