Doctor, Why am I Hoarse?
Hoarseness is a general term that describes abnormal voice changes. When hoarse, the voice may sound breathy, raspy, strained, or there may be changes in volume (loudness) or pitch (how high or low the voice is). The changes in sound are usually due to disorders related to the vocal cords that are the sound producing parts of the voice box (larynx). While breathing, the vocal cords remain apart. When speaking or singing, they come together, and as air leaves the lungs, they vibrate, producing sound. Swelling or lumps on the vocal cords prevent them from coming together properly and changes the way the cords vibrate, which makes a change in the voice, altering quality, volume, and pitch. Hoarseness can have several causes:Acute Laryngitis: There are many causes of hoarseness. Fortunately, most are not serious and tend to go away in a short period of time. The most common cause is acute laryngitis, which usually occurs due to swelling from a common cold, upper respiratory tract viral infection, or irritation caused by excessive voice use such as screaming at a sporting event or rock concert. Vocal Nodules: More prolonged hoarseness is usually due to using your voice either too much, too loudly, or improperly over extended periods of time. These habits can lead to vocal nodules (singers’ nodes), which are callous-like growths, or may lead to polyps of the vocal cords (more extensive swelling). Both of these conditions are benign. Vocal nodules are common in children and adults who raise their voice in work or play. Gastroesophageal Reflux: A common cause of hoarseness is gastro-esophageal reflux, when stomach acid comes up the swallowing tube (esophagus) and irritates the vocal cords. Many patients with reflux-related changes of voice do not have symptoms of heartburn. Usually, the voice is worse in the morning and improves during the day. These people may have a sensation of a lump in their throat, mucus sticking in their throat or an excessive desire to clear their throat. Smoking: Smoking is another cause of hoarseness. Since smoking is the major cause of throat cancer, if smokers are hoarse, they should see an otolaryngologist. Other Causes: Many unusual causes for hoarseness include allergies, thyroid problems, neurological disorders, trauma to the voice box, and occasionally, the normal menstrual cycle.
- Hoarseness lasting longer than two weeks especially if you smoke
- Pain not from a cold or flu
- Coughing up blood
- Difficulty swallowing
- Lump in the neck
- Loss or severe change in voice lasting longer than a few days
- If you smoke, quit.
- Avoid agents that dehydrate the body, such as alcohol and caffeine.
- Avoid secondhand smoke.
- Drink plenty of water.
- Humidify your home.
- Watch your diet–avoid spicy foods.
- Try not to use your voice too long or too loudly.
- Use a microphone if possible in situations where you need to project your voice.
- Seek professional voice training.
- Avoid speaking or singing when your voice is injured or hoarse.
- The first is oral preparation, where food or liquid is manipulated and chewed in preparation for swallowing.
- During the oral stage, the tongue propels the food or liquid to the back of the mouth, starting the swallowing response.
- The pharyngeal stage begins as food or liquid is quickly passed through the pharynx, the canal that connects the mouth with the esophagus, into the esophagus or swallowing tube.
- In the final, esophageal stage, the food or liquid passes through the esophagus into the stomach.
Although the first and second stages have some voluntary control, stages three and four occur by themselves, without conscious input.
- a feeling that food or liquid is sticking in the throat;
- discomfort in the throat or chest (when gastroesophageal reflux is present);
- a sensation of a foreign body or “lump” in the throat;
- weight loss and inadequate nutrition due to prolonged or more significant problems with swallowing;
- coughing or choking caused by bits of food, liquid, or saliva not passing easily during swallowing, and being sucked into the lungs.
- eat a bland diet with smaller, more frequent meals;
- eliminate alcohol and caffeine;
- reduce weight and stress;
- avoid food within three hours of bedtime; and
- elevate the head of the bed at night.
If these don’t help, antacids between meals and at bedtime may provide relief.
Many swallowing disorders may be helped by direct swallowing therapy. A speech pathologist can provide special exercises for coordinating the swallowing muscles or restimulating the nerves that trigger the swallow reflex. Patients may also be taught simple ways to place food in the mouth or position the body and head to help the swallow occur successfully.
Some patients with swallowing disorders have difficulty feeding themselves. An occupational therapist can aid the patient and family in feeding techniques. These techniques make the patient as independent as possible. A dietician or nutritional expert can determine the amount of food or liquid necessary to sustain an individual and whether supplements are necessary.
Once the cause is determined, swallowing disorders may be treated with:
- swallowing therapy
Surgery is used to treat certain problems. If a narrowing or stricture exists, the area may need to be stretched or dilated. If a muscle is too tight, it may need to be dilated or released surgically. This procedure is called a myotomy and is performed by an otolaryngologist–head and neck surgeon.
Many causes contribute to swallowing disorders. If you have a persistent problem swallowing, see an otolaryngologist–head and neck surgeon.