Hoarseness occurs when it is difficult for one to produce sounds whilst attempting to speak. Most people can experience hoarseness when suffering a cold; however, some people may suffer from hoarseness chronically. Chronic hoarseness is an extremely frustrating problem that can interfere with work and social life.
Acute hoarseness only lasts for a short period of time (2 weeks or less). Acute hoarseness can be caused by something as simple as yelling or shouting too much, or a cold. Viral laryngitis is the most common cause of acute hoarseness. Acute hoarseness can be relieved by drinking plenty of water and keeping well hydrated, limiting the amount of time spent talking and avoiding activities that strain the vocal cords (i.e. whispering and shouting). Stopping smoking, or at least reducing the number of cigarettes, can also help improve hoarseness.
Gastro-oesophageal reflux (GORD) and hoarseness
GORD is another problem causing hoarseness. GORD is a condition where stomach acid moves back up the oesophagus. In some people, the acid can travel all the way up to the larynx (the voice box) and irritate the vocal cords, causing hoarseness. Chronic acid reflux and damage to the larynx and the vocal cords can produce serious changes to the larynx. This can change our voice and cause other pathologies in the larynx. Taking medications for GORD is one measure which can help to limit its effects on the larynx.
If the hoarseness has been present for more than 2-3 weeks, it is important to seek the advice of a medical practitioner. There are many possible reasons for chronic hoarseness, including:
- Nodules, polyps and cysts on the vocal cords
- Neurological causes – stroke, Parkinson’s disease
- Cancers of the larynx (these are rare)
- Problems originating in the thyroid gland
- Injury to the vocal cords
1. Nodules, Polyps & Cysts
Nodules, cysts and polyps are all benign (non-cancerous) growths which can affect the vocal cords. Nodules are particularly common in singers and people in other professions where they are required to use their voices frequently (teachers, lecturers, pastors). Constant strain on the vocal cords may encourage areas under stress to develop soft swellings. These swellings may become harder over time and form a nodule. Nodules tend to affect both vocal cords.
Polyps can affect either one or both vocal cords. They are softer than nodules – nodules are more like a callus, whereas polyps are blisters in the mucous membrane covering the vocal cord. Polyps can become so large that they cover the entire vocal cord.
Treatment for such lesions can include any one or several of the following options; rest, speech therapy, biopsy and surgery. Although cancer of the larynx is uncommon, biopsy of a nodule or other suspected benign growth may be warranted in order to rule out a malignancy. In some cases, rest alone will be enough to shrink a nodule and return the voice to its normal quality. Speech therapy can also help sufferers of vocal cord nodules and polyps, and is necessary following surgical removal of the lesion.
2. Neurological Causes – Parkinson’s disease, Stroke
Parkinson’s disease is a degenerative neurological disorder which gradually becomes worse as time progresses. It affects part of the brain called the substantia nigra, which contains neurons that produce a chemical neurotransmitter called dopamine. Dopamine is important for the control of fine movements.
Fine control of the muscles in the larynx is important to produce the delicate movements responsible for clear and normal speech. In Parkinson’s disease, some of the muscles involved become stiff and rigid, which may lead to hoarseness or soft speech. Speech therapy can help to improve this.
Hoarseness may also be a symptom arising after a stroke. A stroke may damage the nerve pathways in the brain that help to send signals to and control the movements of the larynx. If there is damage to these pathways, it may affect one’s ability to speak and swallow safely. In patients who have a stroke in the part of the brain that joins the spinal cord, called the brainstem, hoarseness can result. This is because the muscles on only one side of the larynx are paralysed.
3. Laryngeal Cancers
Laryngeal cancers are rare; they are malignant growths on the vocal cords. One symptom of laryngeal cancer is persistent, chronic hoarseness. Other symptoms of cancer of the larynx include:
- A lump in the neck
- Bad breath (also called halitosis)
- Sore throat and a persistent cough
Smoking is a major risk factor for cancers of the larynx.
4. The Thyroid Gland
Interestingly, hoarseness may be a symptom of a problem with the thyroid gland. It can also occur following surgery on the thyroid gland. This is because one of the nerves to the larynx, called the recurrent laryngeal nerve, runs very close to the thyroid gland and is at risk of damage during surgery.
Hypothyroidism is a condition where the thyroid gland is underactive and does not produce enough thyroid hormones. Hypothyroidism can cause local inflammation and pressure. Because the larynx is very close to the thyroid gland, the pressure or inflammation may affect the larynx, causing hoarseness of the voice. Thyroid cancers can also present with hoarseness.
A goitre is a swelling of the thyroid gland. Goitre can occur as the result of either hypothyroidism or hyperthyroidism (overactive thyroid gland). Goitre can also produce hoarseness due to its effects of placing extra pressure on the larynx.
Hoarseness can be caused by smoking. The inhaled smoke irritates the larynx and the vocal cords, which can make the voice sound hoarse. Smoking is the most important risk factor for cancer of the larynx, which as mentioned above, is a potential cause of hoarseness.
6. Injury to the Vocal Cords
As mentioned earlier, surgery to the neck region can risk injury to the recurrent laryngeal nerve. Hoarseness can be the result of injury to this nerve. Intubation during surgery can also damage the larynx and/or the recurrent laryngeal nerve. Insertion of the tube can directly injure the vocal cords themselves or may dislocate some of the cartilages of the larynx.
If you have concerns about voice change or hoarseness contact your local doctor who will arrange for you to see an ear nose and throat specialist.