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Unusual changes in the voice are termed “hoarseness”. When you are hoarse, your voice may be described as raspy, breathy, strained or there may be changes in volume or pitch. Hoarseness commonly occurs when there is a change in the sound-producing parts of the voice box (larynx), called the vocal cords. When speaking, the vocal cords come together to produce the sound of a voice. However, any abnormality which does not allow for the vocal cords to move freely or to approximate together, creates the altering voice quality, pitch or volume that we call hoarseness.

What are the causes of hoarseness?

Acute laryngitis

Acute laryngitis is the most common cause of sudden onset hoarseness. It is frequently caused by a viral infection which causes swelling of the vocal cords, affecting their vibration with resultant hoarseness. Similarly, voice misuse (or abuse) can also simulate the signs of acute laryngitis. Misuse of the voice occurs when an individual excessively strains their voice by shouting at high volume for long periods of time. Furthermore, voice misuse and overuse puts the individual at risk for developing benign vocal cord lesions or a vocal cord hemorrhage.

Benign vocal cord lesions

These are benign (non-cancerous) growths on the vocal cords, and they include nodules, polyps and cysts. Vocal nodules (singer’s nodes) are callus-like growths of the vocal cords. They occur on both vocal cords opposite each other at the point of maximum vocal cord contact. Treatment often requires voice rest with microsurgical treatment for those who do not respond to conservative measures.

Vocal cord hemorrhage

This occurs when one of the blood vessels on the surface of the vocal cord breaks open, with a resulting hematoma (or bruise) on the surface of the vocal cord. Many consider this to be a vocal emergency, treated with complete voice rest until the hematoma resolves.

Reflux – gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LPRD)

A common cause of hoarseness is reflux of acid from the stomach coming up the esophagus to irritate the vocal cords (GERD). Many patients with reflux-related vocal changes do not complain of heartburn. Usually, they notice a sensation of a lump or mucous in their throat and have an excessive desire to clear the mucus. Usually the voice is worse in the morning and improves during the day. When reflux progresses past the vocal cords and into the back of the throat, it is then called LPRD.

Neurological Disorders

Hoarseness can occur when there is a problem in the nerve supply to the larynx. The most common abnormality is a weakness or paralysis of one of the vocal cords. This condition most frequently occurs from a viral infection of the nerves, but can also occur after surgery in the neck or chest or from a tumor involving the nerves.

Laryngeal Cancer

Throat cancer is a very serious condition demanding prompt medical attention. It can be characterized by chronic hoarseness that does not resolve, particularly in smokers. Immediate attention to changes in the voice facilitate timely diagnosis, and laryngeal cancer is highly curative when diagnosed in its early stages.

When should I see an otolaryngologist?

  • If the hoarseness lasts longer than 2 weeks
  • If you smoke
  • If you’re coughing up blood
  • If you have difficulty swallowing
  • If you feel a lump in the neck
  • If you experience painful speaking or swallowing
  • If there is also difficulty breathing in conjunction with your voice change

The doctors at Affiliated Ear, Nose and Throat Physicians are experts in the diagnosis and treatment of hoarseness and other throat conditions. Please contact us at any of our office locations to set up a consultation.


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