HOARSENESS
Hoarseness is having difficulty
producing sound
when trying to speak or a change in the pitch or quality of the voice.
The voice may sound weak, very breathy, scratchy or husky.
Causes:
1.Acute Laryngitis: The most common cause is acute laryngitis -
swelling of the vocal folds that occurs during a common cold, upper respiratory
tract viral infection or from voice strain. Serious injury to the
vocal folds can result from strenuous voice use during an episode of
acute laryngitis.
2.Voice Misuse:-
- •Speaking in noisy situations
- •Excessive use
- •Telephone use with the
handset cradled to the shoulder
- •Using inappropriate pitch
(too high or too low) when
speaking
- •Not using amplification when
public speaking
3.Benign
Vocal Cord Lesions: Prolonged
hoarseness can occur when you use your voice too much, or too loudly
for extended periods of time. These habits can lead to nodules, polyps,
and cysts. Vocal nodules (singers' nodes) are callus-like growths of
the vocal folds. Vocal fold polyps and cysts also occur in those who
misuse their voice, but can also occur in those who do not.
4.Vocal Hemorrhage: If you experience a sudden loss of voice following
a yell or other strenuous vocal use, you may have developed a vocal
fold hemorrhage. Vocal fold hemorrhage occurs when one of the blood
vessels on the surface of the vocal folds ruptures and the soft tissues
fill with blood. It is considered a vocal emergency and should be
treated with absolute voice rest and examination by an otolaryngologist
(ear, nose, and throat doctor).
5.Gastro-oesophageal Reflux (GERD): A possible cause of hoarseness is
gastro-esophageal reflux, when stomach acid comes up the swallowing
tube (esophagus) and irritates the vocal folds. Other typical symptoms
of GERD include heartburn and regurgitation. Usually, the voice is
worse in the morning and improves during the day. These people may have
a sensation of a lump or mucus in their throat and have an excessive
desire to clear it.
6.Laryngo-pharyngeal Reflux (LPRD): If the reflux makes it all the way
up through the upper sphincter and into the back of the throat, it is
called LPRD rather than GERD. The structures in the throat (pharynx,
larynx, and lungs) are much more sensitive to stomach acid and
digestive enzymes, so smaller amounts of the reflux into this area can
result in more damage. Many patients with LPRD do not have
hearburn or other classic symptoms of GERD.
7.Smoking: Smoking is another cause of hoarseness. Because smoking is
the major cause of throat cancer, if smokers become hoarse, they should
see an otolaryngologist.
8.Neurological Diseases or Disorders: Hoarseness can also appear in
those who have neurological diseases such as Parkinson's or a stroke,
or may be a symptom of spasmodic dysphonia, a rare neurological
disorder that usually affects only the voice, but sometimes affects
breathing. A paralyzed vocal fold may be the cause of a weak, breathy
voice. If the hoarseness persists for more than three months and other
causes have been ruled out, a neurologist may be helpful for diagnosis.
9.Other Causes: These include allergies, thyroid problems, trauma to
the voice box, and, occasionally, menstruation. Very serious conditions
such as laryngeal cancer can also cause hoarseness.
Symptoms:
Hoarseness typically gives the voice a raspy and harsh quality, though
it may also cause a change in the pitch or volume of the voice. The
rapidity of onset and any associated symptoms will depend on the
underlying cause leading to hoarseness.
Diagnosis:
Otolaryngologists (ENT specialists) will obtain a thorough history of a
patient's
hoarseness and general health. They will then evaluate the voice and do
a complete ear, nose, and throat exam. This includes examination of the
vocal folds by laryngoscopy. Laryngoscopy may be suggested by
the otolaryngologist at any time during an evaluation for hoarseness,
but if it persists beyond three weeks it should be evaluated and that
evaluation should occur within a maximum of 3 months. The evaluation
should be immediate if there is concern about a serious underlying
cause is suspected.
Doctors usually look at the vocal folds either with a mirror placed in
the back of the throat, or with a very small, lighted flexible tube
(fiberoptic scope) that is passed through the nose to view the vocal
folds. Videotaping or stroboscopy (slow-motion assessment) may also
help with the analysis. These procedures are well tolerated by most
patients. In some cases, special tests designed to evaluate the voice
may be recommended. These measure voice irregularities, how the voice
sounds, airflow, and other characteristics that are helpful in
diagnosing and guiding treatment.
Investigation:
1.Complete Blood Examination.
2.Laryngoscopy
3.Throat culture.
4.X- Ray of neck.
5.CT scan.
Treatment:
The treatment of hoarseness depends on the cause. The infection in the
throat can be treated conservatively. Most hoarseness can be treated by
simply resting the voice or modifying how it is used. Smoking cessation
is suggested for those individuals that smoke.
Homoeopathy: The
homeopathic approach towards hoarseness is more totalistic
and holistic. Rather than considering it a local problem, hoarseness is
considered to be an affection of the constitution. Moreover, allergy
(which lies at the root of this problem) is a constitutional problem
and calls for a constitutional approach for its management. Homeopathic
treatment is based on the same constitutional approach for management
of
any disease. Not only does Homeopathy help in resolving the problem of
hoarseness but it also helps in preventing the recurrence.
Prevention:
•
Hoarseness can be prevented in some instances, for example:
- •Avoid situations that require
excessive strenuous voice
use, and if a person needs to project their voice, use a microphone if
possible.
- •Voice therapists or singing
teachers may be helpful in
certain cases to assist individuals with vocal training and voice
modification.
- •Smoking cessation can prevent
hoarseness or the development
of cancer of the larynx.
- •Individuals with hoarseness
caused by gastroesophageal
reflux (GERD) can benefit from medications and dietary modification.
- •Avoiding of dehydrating
things in diet like alcohol,
caffeine etc.
- •Plenty of water must be
drunk.
- •Spicy food should be avoided.
Please E-mail dr_ramanand@rediffmail.com for any questions/treatment