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What is Voice Hoarseness?

It may be perceived by some as roughness of the voice, a lowered pitch or the inability to sing high notes without the voice breaking.

When hoarseness is persistent, it can lead to voice fatigue and persistent neck soreness. In severe cases, it can even lead to pain in the throat when speaking. Patients with hoarseness are usually unable to project their voices, and straining to do so can worsen the vocal cord injury.

Causes

The most common causes of hoarseness are:

  1. Voice misuse and abuse
    1. e.g. excessive shouting, singing or talking
  2. An upper respiratory tract infection (e.g. sore throat or cold) often with a cough
    1. Most people recover within 2 weeks
    2. Otherwise, you should consult a voice specialist (laryngologist)
Diagnosis
  1. Determine How the Hoarseness Started
    1. Certain lifestyle choices (e.g. smoking, alcohol)
    2. Patterns of vocal use (misuse and abuse)
    3. Medical conditions (e.g. nasal allergies, asthma, sinusitis, reflux)
  2. Evaluation of Nasal Passages, Ears & Throat
    1. To exclude certain medical conditions that can cause hoarseness
  3. Stroboscopy of the Vocal Cords
    1. Allows the doctor to examine the vibration of the vocal cords and the surrounding structures in great detail
Treatment

Treatment of voice hoarseness involves lifestyle and diet changes, control of underlying medical conditions, voice hygiene as well as voice therapy. Surgery is usually not necessary for a majority of patients.

  1. Voice Therapy
    1. Optimises voice production by balancing the flow of air through the vocal cords and connecting it with the upper airway passages
    2. The therapist will use a variety of methods, including home exercises and advice on how to translate them into everyday voice use
  2. Micro-laryngeal Surgery
    1. Some conditions may only respond to surgery (e.g. vocal cord cysts and polyps)
    2. Any medical conditions that cause vocal cord inflammation (e.g. nasal allergies, sinus infections) must be treated first
    3. Patients usually require at least 2 weeks post-surgery to rest their voices
  3. Surgery for Laryngeal Papillomatosis
    1. A rare disorder characterized by recurrent benign exophytic wart-like growths along the aero-digestive tract
    2. Treatment include CO2 laser and antiviral drugs (Cidofovir)
  4. Laser Surgery for Laryngeal Cancer
    1. Early cancers of the larynx can be treated with CO2 laser excision
    2. Excellent long term cure rates
  5. Injection Laryngoplasty & Laryngeal Framework Surgery
    1. Patients with vocal cord paralysis may suffer from a soft, breathy voice due to a large air leak between the weak vocal cords
    2. Injection Laryngoplasty
      1. Injects fillers into the vocal cords to “plump” them up
      2. May not be permanent and may have to be repeated
    3. Laryngeal Framework Surgery
      1. Creates a “little window” through the Adam’s apple and inserts a prosthesis to push the vocal cord towards the centre
      2. This reduces the air leak and restores the voice
  6. Botox Injections
    1. Used to treat voice conditions where patients face difficulty controlling the texture of their voice (i.e. it may sound tight and strangled)
    2. Other uses of Botox include reduction of salivation and drooling (e.g. in stroke patients), and improving the passage of food into the oesophagus
Know Your ENT Specialist
Dr Paul Mok
Senior Consultant ENT Surgeon
MBBS, FRCS (Glasgow), FAMS (ORL)

Dr Paul Mok Kan Hwei is a certified specialist in Otolaryngology, Head and Neck Surgery (ENT) and has had a distinguished career in public service for the past 23 years.

He cares for patients with a wide variety of ENT conditions including managing patients with nasal allergies, sinus infections, ear problems and swellings in the head and neck region. His special areas of interests are in Voice, Swallowing and managing patients with Obstructive Sleep Apnea.