We all want a pleasant voice. Hoarseness is an abnormal, unpleasant change in the quality of the voice. It‘s a symptom, not a disease. It can affect the clarity, loudness and/or vocal effort of the individual. It’s a signal of an underlying problem that makes it more difficult to communicate with others. It’s never normal.
At any given time, several million people have hoarseness in the US costing several billion dollars annually in lost work productivity. Social isolation, depression and decreased quality of living have occurred particularly when hoarseness was due to neurologic problems (Parkinson’s disease, paralyzed vocal fold, or vocal tremor).(1)
Just as the face is a distinguishing characteristic of our persona, so too is the voice. The voice possesses a certain richness, volume and range that makes it unique and as identifiable as a fingerprint.(2)
A healthy voice is one in good physical shape and functions normally. It stars off as a breath stream from the lungs moving upwards that causes movement of the vocal folds. This passive movement of the folds produces vocal sounds that are eventually shaped into speech or song.
If you separate the index finger and middle fingers of your hand, that’s a very rough idea of the V shape configuration of the vocal folds of the larynx (voice box). When you put these same two fingers together, it can be a reminder that the vocal folds need to come together in order to produce sound. What can go wrong?
In the 1990’s former President Bill Clinton complained of hoarseness. The hoarseness was attributed to a combination of allergies, vocal misuse and reflux disease. The exact details of his voice problem were never fully revealed.
Julie Andrews, in 1997, underwent a throat operation that she claims ruined her vocal folds resulting in hoarseness and an inability to sing professionally.
There are more than thirty causes of hoarseness but they most often damage two aspects of voice. One is loudness, (the intensity of the voice). The other is the quality of the voice.
Any disorder that prevents the normal movement of the vocal folds or interferes with the passage of the breath stream from the lungs causes hoarseness. Most of the time the hoarseness is mild and temporary, But it can be severe, persistent, wreck a professional’s career or be a symptom of a cancerous growth.
Common Causes of Hoarseness
- Voice abuse — misuse
- Acid Reflux disease
- Smoking
- Viral infections of the Upper Respiratory Tract
- Allergies
Viral infections of the upper respiratory tract (e.g. laryngitis, the common cold) are often the cause of hoarseness or roughness in the voice. Vocal abuse happens when you speak improperly, too loudly or talk excessively. Smoking can make the voice sound harsh and rough. If there’s a notable change in a smoker’s voice, the larynx should be examined.
Allergies can make the vocal folds swell creating hoarseness. When stomach acid goes up the swallowing tube (the esophagus) it can irritate the vocal folds and cause hoarseness. It is called silent reflux when it happens in the absence of heartburn.(3) Laryngeal irritation (swelling, redness) also happens in the presence of heartburn.
Some of the other causes of hoarseness beside those noted above, although less frequent, are potentially more serious. In this category are grpwths and tumors of the larynx, neurological problems, (Parkinson’s disease, stroke — see above) and thyroid disorders.
Treatment
Treatment is directed at the underlying cause of the hoarseness. Voice rest and speech therapy are useful for patients who abuse their voice. Antibiotics are indicated in patients with bacterial upper respiratory infections. Laryngeal surgery might be indicated for growths, tumors or lesions of the voice box. Botox injections have been used in patients with spasmodic dysphonia (spasms of the voice box muscles).
Perhaps the simplest and best advice is to use your voice properly. If you smoke, quit. If you have hoarseness for two or three weeks without any apparent reason, make an appointment with an ENT specialist to exam the larynx.
- Rosenfeld, Richard M.; AAO-HNS Clinical Practice Guideline: Hoarseness; Sept.1, 2009
- Anticaglia, Joseph R.; Voiceprints, Your Unique Voice; HCSmart, March 6, 2016.
- Laryngopharyngeal Reflux Disease (LPRD)
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.