Hoarseness

Doctor, Explain Hoarseness
Insight into causes, prevention, and when to see an ENT

How Are Vocal Disorders Treated?
The treatment of hoarseness depends on the cause. Most hoarseness can be treated by simply resting the voice or modifying how it is used. The otolaryngologist may make some recommendations about voice use behavior, refer the patient to other voice team members, and in some instances recommend surgery if a lesion, such as a polyp, is identified. Avoidance of smoking or exposure to secondhand smoke (passive smoking) is recommended to all patients. Drinking fluids and possibly using medications to thin the mucus are also helpful.

Specialists in speech/language pathology (voice therapists) are trained to assist patients in behavior modification that may help eliminate some voice disorders. Patients who have developed bad habits, such as smoking or overuse of their voice by yelling and screaming, benefit most from this conservative approach. The speech/language pathologist may teach patients to alter their method of speech production to improve the sound of the voice and to resolve problems, such as vocal nodules. When a patients’ problem is specifically related to singing, a singing teacher may help improve the patients’ singing techniques.

What can I do to prevent and treat mild hoarseness?
• If you smoke, quit.
• Avoid agents which 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 in situations where you need to protect your voice.
• Seek professional voice training.
• Avoid speaking or singing when your voice is injured or hoarse. Don’t sing when you are sick.

Who Can Treat My Hoarseness?
Hoarseness due to a cold or flu may be evaluated by family physicians, pediatricians, and internists (who have learned how to examine the larynx). When hoarseness lasts longer than two weeks or has no obvious cause it should be evaluated by an otolaryngologist–head and neck surgeon (ear, nose and throat doctor). Problems with the voice are best managed by a team of professionals who know and understand how the voice functions. These professionals are otolaryngologist–head and neck surgeons, speech/language pathologists, and teachers of singing, acting, or public speaking. Voice disorders have many different characteristics that may give professionals a clue to the cause.

How Is Hoarseness Evaluated?
An otolaryngologist will obtain a thorough history of the hoarseness and your general health. Your doctor will usually look at the vocal cords with either a mirror placed in the back of your throat, or a very small, lighted flexible tube (fiberoptic scope) may be passed through your nose in order to view your vocal cords. Videotaping the examination, or using stroboscopy (slow motion assessment) may also help with the analysis.

These procedures are not uncomfortable and are well tolerated by most patients. In some cases, special tests (known as acoustic analysis) designed to evaluate the voice, may be recommended. These measure voice irregularities, how the voice sounds, airflow, and other characteristics that are helpful in establishing a diagnosis and guiding treatment.

When Should I See an Otolaryngologist (ENT doctor)?
• 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