Voice loss and hoarseness are common problems cared for in the otolaryngologist’s (ENT) office on a daily basis. The frequency of these complaints does seem to increase in the winter months. It’s likely that upper respiratory infections are playing a role in this seasonal increase.
There are a few different things that can cause voice loss or hoarseness. The first common cause is acute laryngitis. Acute laryngitis is typically a viral infection that involves the larynx or voice box. The most common viruses are rhinovirus, influenza A, B, or C, and parainfluenza. These same viruses are responsible for the common cold and flu. When a person develops laryngitis, the vocal cords get very swollen which leads to voice changes and occasionally swallowing problems. Treatment for this problem is supportive with good oral hydration, rest, and, when the voice is affected, avoiding its overuse. Antibiotics are not required. These symptoms typically will resolve within 7 days but can persist. When symptoms last longer than 2 weeks we start wondering about other causes.
Chronic laryngitis may start as an acute infection or may gradually worsen. This problem can be caused by bacteria that have infected the voice box or even fungi. This problem requires more aggressive treatment and monitoring by an otolaryngologist. Antibiotics or antifungals are typically required. One population at special risk for this problem are people using steroid inhalers for asthma or COPD.
Hoarseness, however, is not always caused by infections. In fact, it usually isn’t! Other things that can affect the voice include acid reflux, problems with vocal cord movement, lesions or masses on the vocal cords, and voice misuse.
Patients with acid reflux related voice problems often don’t have the typical symptoms of acid reflux such as burning in the chest. Often the symptoms of this reflux are the sensation of a lump in the throat, thick mucus, cough, throat clearing, belching, or a sore throat. The good news is this problem typically responds well to treatment which includes lifestyle modifications to reduce the frequency and severity of acid reflux with or without medications.
Vocal cord movement problems and vocal cord lesions or masses are diagnosed by an otolaryngologist who will use a fiberoptic scope to inspect the voice box in the office. Benign lesions like nodules can be treated with voice therapy and voice rest while cancerous lesions need to be removed and may require further treatment.
In general, hoarseness can result from many different problems. It is wise to treat hoarseness of a short duration (less than a few weeks) conservatively but when it persists a visit to an otolaryngologist is wise. You can expect a thorough history and physical exam including palpating the neck and voice box externally. In addition, the exam will often be aided by the use of a fiber-optic scope to inspect the voice box internally. This scope is quite small in diameter and the exam will be done in the office. Often a medication will be sprayed in the nose to numb the surface allowing for the exam to be performed with less discomfort. Patients tolerate this well and benefit from an inspection of an area that is otherwise inaccessible.