Blog

December 24, 2019

Horseness of voice

What is Hoarseness?

Hoarseness or Dysphonia means a change in the sound of somone’s voice.people suffering from hoarseness can experience a strained,husky or breathy voice.

They may also notice a difference in loudness and change in how high or low their voice sounds(pitch)

Changes in voice pitch are common in young children as they grow through puberty (voice ‘breaking’)

A complete loss of voice,resulting in only a whisper,is called aphonia.

What causes Hoarseness ?

Normally when we talk/sing the vocal cords come together and vibrate.This creates a sound which we konw as the voice. Hoarseness results from the vocal cords in the voice box(laynx)not working properly.There are several causes of hoarseness fortunately most are not serious and tend to go away after a short period of time.

Common causes are:

A viral upper respiratory tract infection,causing the voice box lining to swell (laryngitis)

Stomach acid/enzymes irritating the throat (laryngopharyngeal reflux)

A build-up of soft tissue (polyps)or thicking (nodules)on the vocal cords .These can develop when the voice is used too much or too ludly for long periods of time(Singer’s Nodules).vocal cord polyps are often related to smoking.

Rarely a growth or tumour develops on the vocal cords and or voice box.These may be non-cancerous (benign) or cancerous (malignat)

Problem with movement of the vocal cords (paralysed vocal cords).One or Both of the vocal cords may be paralysed if it’s nerve is affected by infection or tumor.

How is Hoarseness treated?

A key question here is whether the hoarsenss is constant or getting worse or does it come and go with periods of ‘normal’voice in between.

Intermittent mild episodes of hoarseness:

In most cases this will settles by itself.To help relieve the symptoms one can;

Rest the voice (but don’t resort to whispering which can make matters worse).

Drink plenty of fluids

Avoid alcohol.

Avoid cigarette smoking.

Take antacids e.g Gaviscon if you get a build – up of acid in the throat.

Persistent and /or worsening Horseness

People suffering from the following symptopms should seek urgent medical advice from their family doctors(GP):

Prolonged hoarseness for more than four weeks.

Repeated spells of hoarsensess without reason.

Prolonged sore throat or difficulty swallowing for more than two weeks.

It is particularly important to see the ENT Doctor with these symptoms if the person is a smoker or drinks more than the recommended amount of alcohol.

What will the ENT surgeon do?

The surgeon will examine the throat to help identity the cause of the hoarseness. This is done by passing a flexible telescope through the nose(fibreoptic endoscope). This examination is done at the time of your out-patient visit and does not require hospital admission. Depending on the clinical findings,the following treatments may be recommended.

Simple advice: As described above for intermittent mild hoarseness.

Voice therapy(speech and language therapist):

The majority of patients will have no structural abnormality identified. The problemwith their voice will be related to the way they are using their voice i.e they are straining it in some way. In this case a voice therapist will be able to give advice or suggest exercise that might help the quality of the voice. Voice therapy may require more than one visit to the therapist.

Microlaryngoscopy :

An operation to remove nodules, polyps and non cancerous (benign) tumours may be recommmended if these are identified at the outpatients visit. This type of operation is usually done under general anaesthetic using a rigid telescope (Endoscope)and a microscope(to provide magnification). It can remove the problem in the case of polyps,nodules or cysts and will provide a piece of tissue for laboratory analysis (a biopsy). If a malignant (cancerous) tumour of the larynx is diagnosed by biopsy then further treatment will be planned at a cancer team meeting and discussed with the patient.

Possible treatment options for cancer are:

Radiotherapy:

Hight energy x-rays are used to kill cancerous tumours on the vocal cords and voice box. Radiotherapy is usually provided by a clinical oncologist and usually involves daily treatments, 5 days of the week for approximately 5-6 weeks. Radiotherapy can cause a number of side effects which the surgeon/onologist will explain.

Surgery:

This may involve removal of part(partial laryngectomy)or all the voice box(Total laryngectomy). This major surgery involves operating through the skin of the neck and may result in an opening for the windpipe in the front of the neck(Tracheostomy).

Alternatively for some tumours surgery can be performed using a telescope(Endoscope)through the mouth,removing the tumour using laser. This avoids the need for surgery through hte neck. There is ongoing debate regarding the value of different forms of surgery and surgeon will discuss what is best for the patient.

If surgery to remove all the voice box is required(Total laryngectomy) then there are several ways of allowing a patient to regain their speech. The commonest form is the use of a speaking valve inserted through the trachestomy opening. The surgeon and the voice therapist will discuss this in detail and training will be given to help.