A B C D E F G H I J K L M N O P R S T U V W

HOARSENESS - LARYNGITIS

What is Hoarseness ?

The vocal cords are situated in the voice box. The voice is produced by vibrations of the vocal cords. In turn caused these are caused by movement of the air during breathing. The muscles of the voice box vary the position and tension of the vocal cords. In this way, we can control the sounds we make. The smooth edges of the vocal cords are crucial for the correct quality of the sound. Laryngitis is an inflammation of the voice box (larynx). Hoarseness is an alteration in the sound of the voice. It may be a gruffness, have a high-pitched quality or produce a deepening of the voice. In some cases the voice is very weak and it may be impossible to speak. Lanyngitis is one of the many causes of hoarseness and there are in turn many causes of laryngitis.

How does Hoarseness occur ?

Laryngitis may result from infections with viruses or bacteria and occurs often with the common cold. Inflammation causes the tissues of the larynx to swell. This swelling involving the vocal cords causes hoarseness. In addition to the voice change there will be discomfort or pain in the throat. There may also be general symptoms such as fever and feeling unwell. Damage to the vocal cords by misuse or overuse of the voice can also produce hoarseness. This condition is called vocal abuse.

Why does Hoarseness occur ?

Apart from the common condition of laryngitis there are many causes of hoarseness. Congenital (present from birth) causes are rare. Most cases are due to inflammation, and some are produced by exposure to dust fumes and irritants. The most important of these is tobacco smoke. People with chronic nasal infections or sinusitis and chronic chest conditions are more likely to have chronic laryngitis. Often there is a combination of causes. Growths of the voice box which involve the vocal cord may cause hoarseness. Some of these growths are benign but some are cancers. The malignant tumours or cancers are much more common in people who smoke. Conditions which interfere with the movement of the vocal cords will also cause hoarseness. Paralysis of the nerve which triggers the vocal cords is not uncommon. This is called recurrent laryngeal palsy. Sometimes the cord will be prevented from moving by arthritis in the larynx. An underactive thyroid gland (myxoedema) can also cause hoarseness. The voice box is a mirror which reflects the ills of man. This includes stress. Stress can lead to misuse of the muscles around the vocal cords. This in turn produces hoarseness. Prolonged use of the voice in certain professions is well known to cause problems. Teachers and singers are among the main sufferers. Sometimes emotional crises can produce loss of voice.

Treatment Involved for Hoarseness

Simple acute laryngitis will get better in a few days. Because the voice box is very small in children, the swelling of the tissues may produce some obstruction to breathing. This usually causes noisy breathing (stridor). Steam inhalations are helpful. For children they are most easily provided by running a hot bath and sitting in the bathroom with closed doors and windows. Antibiotics may be used when the infection is obviously severe and accompanied by local pain and general symptoms. The voice must be rested. Failure to rest the voice during an acute infection of the larynx may cause permanent damage to the cords. Steam inhalations may give relief. They may contain medication such as menthol or Friar's Balsam. It is advisable to avoid tobacco smoke. Chronic laryngitis and hoarseness of more than a few weeks duration require investigation. The voice box should be examined by a specialist. This is done with a small mirror with or without a local anaesthetic spray. Sometimes a very fine fibre-optic instrument introduced through the nostril will allow a view of the larynx. If the view is not sufficient a general anaesthetic may be needed. With the patient asleep an examination (direct laryngoscopy) will also allow a specimen to be taken for analysis (biopsy). Hoarseness which is accompanied by obstruction to breathing requires urgent admission to hospital.

After Treatment for Hoarseness

Further alteration or worsening of the voice may indicate a change in the larynx. Regular visits to a specialist or clinic may be advised for repeated examination. Voice change which persists for more than 4 weeks must be looked into further.

If Hoarseness is Left Untreated

Very rarely, chronic changes in the tissues of the voice box have a tendency to become malignant. Fortunately early malignancy of the vocal cord responds very well to radiotherapy. Hoarseness or alteration of the voice must never be neglected. If it persists for more than 3 weeks, it needs urgent specialist opinion.