Hoarseness

Hoarseness is not uncommon, especially following an upper respiratory tract infection. In this situation, the voice usually returns to normal when the infection resolves. When hoarseness lasts longer than several weeks, further evaluation may be indicated.

Gastro-esophageal reflux (GERD) is one of the most common causes of chronic voice changes, yet is often unrecognized. Many individuals with hoarseness from GERD will lack the usual symptoms such as heartburn and an acidic taste in the mouth. Often these individuals will complain of a persistent feeling of something lodged in the throat. Treatment with
medications to prevent reflux as well as dietary and lifestyle modifications are usually successful in treating this cause of hoarseness.

Hoarseness is often secondary to voice abuse. Because the vocal cords are actually muscles, overuse can cause damage just like muscles in other parts of the body. Rest and speech therapy will improve the voice in this situation. Occasionally, the damage incurred from voice abuse will be severe enough to require surgery.

Hoarseness may occur from damage to the nerve supplying the vocal cord. The most common cause of this is unknown. Other causes include thyroid surgery, heart disease and lung cancer. Recent improvements in voice surgery for vocal cord paralysis enable many individuals to regain a normal voice. These techniques may involve placement of fat, muscle lining or a silastic implant to medicalize the vocal cord. Microscopic laryngeal surgery allows for removal of small vocal lesions with good preservation of voice quality.

Hoarseness can also be a manifestation of laryngeal or throat cancer. This is very rare in individuals without a smoking history. Progressive hoarseness with difficulty swallowing, ear pain and weight loss are suggestive of cancer. Evaluation by an ENT should be sought immediately.