Hoarseness and Laryngitis

Hoarseness

Hoarseness is often used to describe a change to the voice. People suffering from hoarseness may experience a strained, raspy and/or breathy voice. People may also notice a difference in how loud they are able to speak and/or changes in how high or low their voice sounds (Pitch).

What causes Hoarseness?

There are several causes of hoarseness, fortunately most are not serious and tend to go away after a short period of time. Hoarseness is a result of the vocal cords in the voice box (Larynx) not working properly. Normally when we talk/sing the vocal cords come together and vibrate. This creates a sound which we know as the voice. There are several reasons why the vocal cords may not be working correctly. The most frequent are:

• · An upper respiratory tract viral infection, which causes the voice box to swell ( Laryngitis)
• · The build up of tissue (polyps) and or callous like growths (nodules) on the vocal cords. These can develop when the voice is used too much or too loudly for extended periods of time (Singer's Nodules)
• · The growth of tumours on the vocal cords and or voice box (larynx). These tumours are may be non cancerous (benign) or cancerous (malignant)
• · Stomach acid irritating the vocal cords (Gastro-oesophageal Reflux)

How is Hoarseness treated?

In most cases hoarseness will clear up on by itself. To help relieve the symptoms it may help to:

• · Rest the voice
• · Drink plenty of fluids
• · Avoid alcohol
• · Not smoke
• · Have bed rest
• · Take common painkillers e.g. Paracetamols or soluble aspirin
• · Take Antacids e.g Rennin, for hoarseness caused by the build up of excess stomach acid in the throat

People suffering from the following symptoms should seek medical advice from their General Practitioner GP):

• · Prolonged hoarseness for over four weeks
• · Repeated case of hoarseness without the symptoms of a viral infection or flu
• · Prolonged sore throat or difficulty swallowing for more than two weeks
• · Severe change in the sound of the voice which lasts for several weeks

The GP may decide to refer you onto to an ENT surgeon. The surgeon will examine the throat to identify the cause of the hoarseness. This is done by passing a flexible telescope to the back of the nose under local anaesthetic (Fibreoptic Endoscope).

Depending on the clinical findings, the following treatment may be advised:

Speech Therapy: The majority of patients will have no structural abnormality identified. The problem with their voice will be related to the way that they are using their voice i.e. they are ‘straining' it in some way. Under these circumstances the speech therapists will be able to advise exercises that might help the quality of the voice.

Microlaryngoscopy: An operation to remove nodules, polyps and non cancerous (benign) tumours may be recommended if these are identified in the outpatients. This type of operation is usually done under general anaesthetic using a rigid telescope (Endoscope) and a microscope (to provide magnification). It will remove the problem in the case of polyps, nodules etc. and will provide a piece of tissue to be looked at under the microscope (a biopsy) and hence make the diagnosis of cancer if the tumour is malignant. If a malignant tumour of the larynx is diagnosed by biopsy then the management options will include:

Radiotherapy: High energy radioactive rays, usually X-rays are used to kill cancerous tumours on the vocal cords and voice box. Radiotherapy is usually provided by a clinical oncologist and can involve daily treatments, 5 days of the week for approximately 5 - 6 weeks. Radiotherapy can cause a number of side effects, which your surgeon will explain.

Surgery: This may involve removal of part (Partial Laryngectomy) or all of the voice box (Total Laryngectomy). Traditionally this surgery has involved cuts (incisions) through the skin of the neck. However, some surgeons are now looking at performing some of this surgery using an telescope (Endoscope) and removing the tumour using a laser, and hence avoiding external incisions. There is some debate regarding the value of different forms of surgery and you would need to discuss this with your surgeon.

After total laryngectomy patients will not breathe and speak in a normal way. Breathing will occur through a permanent opening in the front of the neck (the Stoma or Tracheostoma). Advice and treatment on alternative methods of speaking will be given by the operating surgeon, which could include, surgical voice restoration (inserting a small valve at the time of surgery), oesophageal voice (swallowing air into the stomach and ‘burping' this back up in a controlled way) and artificial voice aids (a hand held vibration source which can be held on the neck).

By C. Milford, Radcliffe Infirmary, Oxford and S. Anuku

Disclaimer
The details in this section are for general information only. Always check with your own doctor.