Is your voice sounding husky or rough all of a sudden? This may be due to the common condition of hoarseness or dysphonia. Hoarseness could be a symptom of problems in the vocal folds in the larynx.

Hoarseness can occur when talking aloud in a crowded place or even due to an underlying medical condition. Generally, hoarseness should recede in a short time, however, if it lasts for more than 3 weeks then it is important to visit a recommended ENT specialist.

How the voice works

One is able to speak with the help of the vocal cords and the voice box. The voice box is situated above the windpipe, with the airway going down to the lungs.

The vocal cords are found inside the larynx and these two bands of muscle expand and close. The air from lungs causes the vocal cords to vibrate, helping generate sound. The pitch of the voice depends on if the vocal cords are relaxed or tense. The voice sounds deeper when the vocal cords are relaxed.

What is hoarseness and the causes behind it?

Dysphonia or commonly known as hoarseness, makes the voice sound strained and raspy. The volume or how loud one speaks will be different and so would be the pitch. It is believed that at least one third of people would experience it sometime in their lives.

Generally, hoarseness is not serious and it tends to go away on its own after a while. However, there could be rare cases that it is due to a serious condition. The usual causes are:

  • Using the voice too much. Speaking too long and with a loud pitch can strain the voice which can lead to hoarseness. In addition, the vocal cords can get limp and thin with age, thus leading to older adults to have a raspier voice.
  • Respiratory tract infections and sinus infections can cause the voice to be hoarse. It will generally resolve within 14 days or so.
  • GERD or gastroesophageal reflux which is commonly known as heartburn, causes the stomach acids to reach the throat and it can impact the vocal folds at times. This can cause hoarseness.
  • Laryngitis can temporarily cause the vocal folds to swell. Allergies can affect the vocal cords to affect sounds.
  • Vocal fold hemorrhage can occur when the voice disappears suddenly, making it noticeably difficult to sing. A vocal fold hemorrhage can occur when blood vessels rupture on the vocal fold, filling with blood.
  • The larynx has muscles controlled by the brain. If you have certain neurological conditions like Parkinson’s disease or a stroke, then it can affect the larynx muscles.
  • Vocal fold paralysis can be brought about when either of the vocal folds don’t work properly. This could happen due to injury to the vocal cords or even due to infection, tumors, stroke, Parkinson’s and multiple sclerosis.
  • Vocal nodules, cysts and polyps can grow on the vocal cords and it can cause friction and pressure leading to hoarseness.
  • Muscle tension dysphonia causes a change in the voice. This is due to excessive muscle tension around the voice box making the efficiency of the voice go down. This condition is brought about by stress and it can exist with other conditions. Laryngitis can bring about muscle tension dysphonia.
  • Laryngeal cancer can bring about hoarseness. If hoarseness lasts for more than 3 weeks, then it is recommended to have a consultation at an experienced ENT practice.

Who is at risk of developing hoarseness?

Hoarseness can be experienced by anyone of any age. However, it is more common in people who smoke. Professional singers and others who use their voice regularly like teachers, call centre operators and other voice-based professions can be affected.

Individuals who have recently had emotional and mental stress too can have hoarseness.

How is hoarseness diagnosed?

The ENT doctor will review the medical history and partake in a  complete physical examination of the neck and head region.

The specialist will check for any lumps and examine the voice box, usually with a laryngoscope. If the ENT doctor feels that there are concerns, then he or she will request a CT or MRI scan or a biopsy.

The ENT Clinic in Singapore is one specially licensed practice that conducts laryngeal video stroboscopy to examine the voice box in detail.

This dynamic examination allows ENT doctors to identify conditions such as vocal cord cysts. This is very helpful for voice professionals to get an expert diagnosis. 

What are the treatment options for hoarseness?

The treatment for hoarseness depends on the kind of symptoms present and the condition which led to it.

  • If the voice has been strained, then resting the voice and keeping the mouth hydrated can help.
  • Upper respiratory tract infections should be left to settle and medications are taken to settle them. If you have laryngitis, then take antibiotics or corticosteroids.
  • Antacids can help to relieve GERD symptoms
  • Treatment of underlying conditions such as neurologic conditions to treat the condition can settle hoarseness.
  • Vocal polyps, cysts and nodules would need to be removed through surgery. To start with dietary changes and voice therapy would be initiated.