Jubilee Hospital, Trivandrum, Kerala,India.
Hoarseness of voice is having difficulty producing sound when trying to speak, or a change in the pitch or quality of the voice. The voice may sound weak, very breathy, scratchy, or husky. Hoarseness is usually caused by a problem in the vocal cords.
Common causes of hoarseness are vocal nodule, laryngitis, edema of vocal cord-Rinks edema, Hypothroidism-myxedema and last but not the least cancer of the larynx. Smoking and alcohol are major risk factors for cancer.
Most causes of hoarseness are not serious and tend to go away in a short period of time. An example is acute laryngitis which is usually associated with the common cold, upper respiratory tract infection, or vocal abuse.
There are other causes like postnasal drainage in chronic sinusitis or gastro esophageal reflux disease-GERD. Neurological disorders can cause impairment of vocal cord paralysis and resulting in weak and breathy voice. This can be caused by tumors of the skull base, neck and chest pressing on the nerve that controls vocal cord movement, viral infections, inadvertent injury during surgery-Thyroid Surgery, blunt neck or chest trauma, and occasionally from endotracheal intubation.
The typical examination for hoarseness includes a full head and neck exam as well as visualization of the vocal cords. Sometimes a full view with a hand held mirror in the throat can be obtained but usually a view with a fiber optic scope is needed.
There are two main types of scopes that may be used. One is a flexible fiber optic scope that is inserted into the nose and gently down into the upper part of the throat. The other scope is a rigid fiber optic scope that provides superior resolution and better detailed visualization of the vocal cords and surrounding throat. This scope is held inside the mouth.
Microlaryngoscopy – Surgery of Vocal cord
Microlaryngoscopy is a procedure that means the vocal cords are looked at in great detail with magnification. The magnification may be with a microscope, endoscope or by video enlargement. It is often accompanied by some additional procedure such as removal of a mass, swelling or tumor. Long delicate instruments or a laser may be utilized. It is sometimes performed in the office, though more typically it is performed in the operating room under general anesthesia.
Treatment of hoarseness depends on the cause. Often behavior modification such as diet and voice rest is all that is needed. Diet modification and medications can help with gastro esophageal reflux. Vocal abuse is often treated with voice rest and may be modified with the help of speech and language pathologists and professional voice trainers. Staying well hydrated and sometimes using medications to thin mucus can help. Avoiding smoking and exposure to second hand smoke will decrease the risk of laryngeal cancer.
Sometimes surgery on the vocal cords will expedite recovery and is often entertained after conservative measures above have failed. Removal of vocal cord nodules or masses will often fail if the initial reasons for vocal abuse are not addressed and removed.
If the reason for hoarseness is related to vocal cord paralysis, speech therapy can improve the voice or a procedure to augment the vocal cord can be done.
A vocal cord injection with an absorbable material can offer a few months relief for patients with a likely temporary vocal cord paralysis).
If Cancer is suspected a biopsy is required for diagnosis but the treatment includes surgery, radiation therapy, chemotherapy or a combination of these treatments.
When to see an ENT Specialist
If you have hoarseness of voice lasting longer than two weeks especially if you smoke and if you have unexplained coughing up blood and difficulty swallowing with a lymph node in the neck.
Appointment
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