Chronic inflammation of the voice box usually manifests itself as hoarseness. Hoarseness is a general term that describes abnormal voice changes. When hoarse, the voice may sound breathy, raspy, strained, or there may be changes in volume (loudness) or pitch (how high or low the voice is). The changes in sound are usually due to disorders related to the vocal folds that are the sound producing parts of the voice box (larynx). While breathing, the vocal folds remain apart. When speaking or singing, they come together, and as air leaves the lungs, they vibrate, producing sound. The more tightly the vocal folds are held and the smaller the vocal folds, the more rapidly they vibrate. More rapid vibration makes a higher voice pitch. Swelling or lumps on the vocal folds prevent them from coming together properly, which makes a change in the voice.
What Are the Causes?
Acute Laryngitis or Pharyngitis
The most common causes are acute laryngitis, which usually occurs due to swelling from a common cold, upper respiratory tract viral infection, or irritation caused by excessive voice use such as screaming at a sporting event or rock concert. These entities are usually self-limiting and simply resolve with time.
Chronic Laryngitis or Pharyngitis
When the symptoms of laryngitis or pharyngitis persist for more than a couple of weeks the cause may differ and it is prudent to be evaluated by your otolaryngologist.
More prolonged hoarseness is usually due to using your voice either too much, too loudly, or improperly over extended periods of time. These habits can lead to vocal nodules (singers nodes), which are callous-like growths, or may lead to polyps of the vocal folds (more extensive swelling). Vocal nodules are common in children and adults who raise their voice in work or play. Uncommonly, polyps or nodules may lead to cancer.
A relatively new entity termed laryngopharyngeal reflux (LPR) has been identified and is surprisingly common. This manifests in relatively younger people with upright reflux primarily irritating the throat and voice box. Interestingly the roll of saliva soothing the throat has been overlooked and keeping well hydrated and even chewing gum frequently can be of immense help.
Smoking is another cause of hoarseness and sore throat. Since smoking is the major cause of throat cancer, if smokers are hoarse or have swallowing difficulties, they should see an otolaryngologist.
Increased thin clear secretions can be due to colds and flu, allergies, cold temperatures, bright lights, certain foods/spices, pregnancy, and other hormonal changes. Various drugs (including birth control pills and high blood pressure medications) and structural abnormalities can also produce increased secretions. These abnormalities might include a deviated or irregular nasal septum (the cartilage and bony dividing wall that separates the two nostrils).
Increased thick secretions in the winter often result from too little moisture in heated buildings and homes. They can also result from sinus or nose infections and some allergies, especially to certain foods such as dairy products. If thin secretions become thick and green or yellow, it is likely that a bacterial sinus infection is developing. In children, thick secretions from one side of the nose can mean that something is stuck in the nose (such as a bean, wadded paper, or piece of toy, etc.). Post-nasal drip often leads to a sore, irritated throat. Although there is usually no infection, the tonsils and other tissues in the throat may swell. This can cause discomfort or a feeling of a lump in the throat. Successful treatment of the post-nasal drip will usually clear up these throat symptoms.
Many unusual causes for hoarseness and dysphagia include allergies, thyroid problems, neurological disorders, trauma to the voice box, and occasionally, the normal menstrual cycle. Nasal airway obstruction can often cause a dry scratchy throat because of chronic mouth breathing. Many people experience some hoarseness or dysphagia with advanced age. Medications, such as “ACE Inhibitors” for blood pressure and newer antidepressants can often cause a tickle or tightness in the throat. When hoarseness or dysphagia 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 folds with a mirror placed in the back of your throat. Occasionally a very small lighted flexible tube (fiberoptic scope) may need to be passed through your nose (or in some cases, a rigid scope may be used which is placed in the back of your mouth) in order to view your vocal folds. Videotaping the examination 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. Swallowing difficulties are also evaluated with endoscopy in the clinic, often with the physician watching the actual swallowing process. Occasionally an x-ray swallowing study or thyroid lab study may be ordered. We utilize the latest techniques and state-of-the-art equipment to evaluate the condition of the vocal cords.
How Are Throat Disorders Treated?
The treatment of hoarseness or dysphagia 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 micro laryngeal surgery if a lesion, such as a nodule or polyp, is identified. We have the latest tools and training available if this is deemed necessary. Avoidance of smoking or exposure to secondhand smoke (passive smoking), as well as drinking plenty of fluids, is recommended to all patients. Acid suppression medications are often tried as a combination diagnostic and therapeutic trial. Allergy testing and immunotherapy can be of tremendous benefit for many.
Specialists in speech/language pathology are trained to assist patients in behavior modification that may help eliminate some voice disorders. Sometimes, patients have developed bad habits, such as smoking or overuse of their voice by yelling and screaming. 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 patient’s problem is specifically related to singing, a singing teacher may help improve the patients’ singing techniques. Some simple things you can do for minor symptoms are:
· If you smoke, quit.
· Avoid agents that dehydrate the body, such as alcohol and caffeine.
· Avoid secondhand smoke.
· Drink plenty of water.
· Regularly chew sugarless gum.
· Elevate the head of your bed slightly.
· Institute nasal salt water rinses.
· Humidify your home.
· Watch your diet–avoid spicy foods.
· Try not to use your voice too long or too loudly.
· Seek professional voice training.
· Avoid speaking or singing when your voice is injured or hoarse.
Problems with swallowing, foreign body sensation, or tight “lump in the throat” feeling are often alleviated by aggressively treating acid reflux and or postnasal drip. After ruling out any thing worrisome we will make a therapeutic plan to fit the individual. Most of these problems are self limiting and benign.