Voice hoarseness is a relatively common issue, stemming from a multitude of causes and treated with a variety of methods including vocal exercises, medications and surgeries.

As the only comprehensive ear, nose, throat speech-language pathology program (ENT/SLP) in the Central Florida area, our Voice Care Center offers complete evaluation and treatment of hoarseness. “One of the most common problems that I treat is hoarseness,” says Gayle E. Woodson, M.D., a board-certified otolaryngology specialist. “People come in because they’ve noticed that they have a problem with speaking.”

Voice hoarseness can represent anything from a raspy, strained or breathy sound to a change in pitch or volume; and often, the source of voice mutations is related to a problem in the vocal cords. “One of the most important things to do when you evaluate someone for hoarseness is to get a really good look at their vocal cords,” says Dr. Woodson.

When breathing in, the vocal cords stay apart, making it practically impossible to speak. But during exhalation the vocal cords come together, and vibrate to produce sound in regular speech. Inflammation or growths on the vocal cords can impede healthy vibration, and change the quality and pitch of one’s voice.

Common Causes or Hoarseness

A wide array of conditions can produce hoarseness of the voice, from simple inflammatory conditions to more significant cancerous or systemic disorders of the larynx (voice box). The causes of hoarseness include:

• Acute laryngitis is the most common cause of hoarseness and can result from a cold, an infection in the upper respiratory tract, or straining the voice.
• Vocal cord lesions stem from excessive loud use of the voice for extended periods of time that can result in nodules, cysts, polyps forming on the vocal cords.
• Vocal cord hemorrhaging occurs during strong shrieks or extremely arduous voice use causing a blood vessel on the vocal cord to burst, filling the soft tissue with blood. This will generate an immediate voice loss and require immediate attention by an ear, nose and throat specialist.
• Gastroesophageal Reflux (GERD) occurs when stomach acid returns up through the esophagus. Along with heartburn and vomiting, it can irritate the vocal cords and result in hoarseness.
• Smoking has a direct link to throat cancer, and it can also cause chronic vocal hoarseness.
• Neurological disorders, such as people with Parkinson’s disease, or those who have suffered a stroke can exhibit vocal changes. A neurologist may be able to help when a patient experiences continuous hoarseness for over three months, with other factors having been ruled out.

Other sources of hoarseness include allergies, voice box trauma, thyroid problems, and, at times, menstruation. Other serious diseases such as laryngeal cancer can provoke hoarseness, so it’s essential to consult an otolaryngologist if you’re experiencing chronic hoarseness.

Evaluation of Hoarseness

Examining and diagnosing the source of voice hoarseness isn’t cut and dry, given the location of the vocal cords and their sensitive nature.

“(The) vocal cords are right here,” says Dr. Woodson pointing to the front of her throat. “You can’t see them when you look in the mouth, it’s actually a 90-degree angle between the mouth and the throat.”

To accurately assess patients, it’s crucial to use the best diagnostic techniques available. Dr. Woodson explains the difference between two commonly used processes: “In order to (see the vocal cords) we either have to put a mirror in the back of your throat which might make you gag, and might not give us the best view. What works best is to put a small flexible scope that goes through your nose and helps us look at your vocal cords.”

Some patients might get squeamish at the thought of a fiber-optic tube going through their nose, but Dr. Woodson says there is nothing to worry about. “The tube is smaller than a pencil, it will even fit into a baby’s nose, and it allows us to go through the nose above the areas that make you gag, and be able to see your vocal cords unimpeded.”

Treatment of Hoarseness

In many common cases of voice hoarseness, the symptoms can be treated with voice rest or by altering use. Your otolaryngologist can advise you on how best to modify your speech behavior. Overall, the exact nature of vocal hoarseness will determine the method of treatment:

• Acute laryngitis due to a cold or an upper respiratory tract infection typically will get better as the virus clears the patient’s system, without prescribing antibiotics. Cough suppressant medicine and the use of a humidifier can provide added benefit.
• Resting the voice is vital to prevent additional aggravation or injury to the vocal cords.
• Quitting smoking is recommended for people who smoke.
• Hoarseness from overuse should be treated with complete voice rest; severe injury to the vocal cords such as hemorrhaging may occur if the voice is used too much.
• If gastroesophageal reflux (GERD) or allergies are the source of hoarseness, they can be treated with appropriate medication.
• In serious situations where cancer of the larynx or benign nodules are involved, surgery may prove to be the best option.