What is hoarseness?

Hoarseness is a very common problem and refers to abnormal voice changes. Hoarseness is a symptom, not a disease and one-third of the US population experiences this symptom at some point in their lives. Hoarseness is more common in those with significant voice strains, such as construction workers, teachers and telephone operators. All ages can be affected, from newborns to seniors. Women are typically affected more often than men. If you are experiencing hoarseness, you should see a healthcare provider for evaluation and care, whether medical or surgical. 

There are many reasons you may experience hoarseness.  If you have been sick, you may have laryngitis.  Viral laryngitis typically resolves itself without treatment and improves with hydration, limited voice use and time. All patients with hoarseness, or a suspected “laryngitis”, that persists beyond two weeks should have an evaluation an ENT provider. 

Several chronic medical conditions such as chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and even rheumatoid arthritis can include hoarseness as a symptom include hoarseness as a symptom.  

COPD

Patients with COPD who feel a severe voice restriction (due to limited breath support and irritation from the use of inhaled steroids which can alter the vibration of the vocal cords) should have an evaluation by an otolaryngologist, ENT provider.

CHF

Cardiac conditions such as CHF can cause changes in the blood vessels around the heart, pushing on the nerve that controls the movement of the vocal cords, resulting in a weak, breathy voice.

Autoimmune Conditions

Rheumatoid arthritis and lupus, among other autoimmune conditions, can cause nodules on the edges of the vocal cords. A possible vocal cord concern related to a medical condition can be diagnosed in a matter of minutes with an ENT provider. ENT physicians receive special training in the study of voice and vocal cord disorders.

Reflux

Reflux is often thought to be a cause for voice concerns, but it does not cause changes in voice quality. While many patients with voice concerns also suffer from reflux, it should not be assumed that a raspy or breathy voice is simply a symptom of reflux. Evaluation with a laryngologist allows a division of reflux symptoms and voice concerns.  A plan for treatment can then be established immediately. Often this treatment is not surgical and involves work with a speech-language pathologist in improving vocal technique and hygiene. Laryngologists are ENT doctors that spend an additional year studying vocal cord function and perform microsurgery on the vocal cords.

While certain medical conditions can cause hoarseness, many illnesses are limited to the vocal cords. The most significant non-medical risk factor that causes voice concerns is smoking. Smoking causes chronic irritation of the thin tissue at the edge of the vocal cords.  This can result in the development of polyps, which causes the classic smoker’s voice. There is also an increased risk of developing vocal cord or laryngeal cancers. 

DISCLAIMER: The contents and opinions expressed by Everett Clinic teammates and providers on “A Healthier You” blog and those providing comments are theirs alone and are not a substitute for medical advice. Consult your own provider for personal health recommendations.