HOARSENESS
Hoarseness and voice problems in general that last longer than 6 weeks must be investigated by an expert. Thorough research always leads to a specific diagnosis. The cause can vary from purely functional (eg incorrect voice use) to purely anatomical (eg vocal cord paralysis). Whatever the cause, there is almost always sufficient treatment possible.
WHAT IS HOARSENESS?
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Everyone knows hoarseness following a banal cold or viral infection. Due to an inflammation and the associated swelling of the vocal cords, we have a hoarse voice for a few days and the situation recovers automatically. However, if a person has voice problems of any kind (eg hoarseness, stuttering or choking) for an extended period or frequently, further investigation is advised.
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Hoarseness technically is an impairment of the signal-to-noise ratio of the human voice, yet a more descriptive definition might be more helpful. Hoarseness can be defined as the unwanted leak of air though the vocal cords or the irregular leak of air through the vocal cords.
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WHAT ARE THE CAUSES?
The causes of hoarseness can be very diverse and range from pure organic (physical) eg a paralysed vocal cord or a tumor to purely functional (for example, due to wrong voice use). Often there is a combination of functional factors and organic. A typical and frequent example of this is hoarseness due to incorrect voice use that leads to the formation of nodular bumps on the vocal cords called vocal cord lumps. Certain voice problems will therefore occur more frequently with certain characters or personalities. For example, extroverted, expressive, speech-loving people start to exhibit faster vocal cord swelling (vocal cord lumps or polyps). There is often a stronger correlation with the character of the patient than with the profession.
WHAT ARE THE RISK FACTORS?
Smokers and singers or persons who frequently use their voice during their profession are at higher risk.
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HOW ABOUT THE EXAMINATION?
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Hoarseness is only a symptom (sign). The studies below will almost always provide a diagnosis and a cause for your hoarseness.
The voicing organ and its function are examined by an ENT doctor and a speech therapist. The voice has 3 functions: breathing, protecting the airway while swallowing and speaking. Every person is dependent on these 3 functions every moment of the day.
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In addition to a thorough survey and a clinical examination of the neck, an inspection of the vocal cords (laryngoscopy) takes place at rest and during vocalization. This is supplemented by a stroboscopy, research in which through short flashes of light, the vibration pattern of the vocal cords is delayed and thus displayed in more detail.
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Then the voice and voice capacity is listened to. One can often hear the nature of the voice problem while speaking. Slipping, softer or louder voices, soft singing etc. can help to find the right cause of hoarseness.
In addition, a voice examination usually takes place, including aerodynamic parameters (the maximum phonation time), acoustically perceptual parameters (eg habitual speech pitch, voice quality in function of the change intensity and pitch) and the vocal range (intensity and frequency dynamics).
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If the cause or complete diagnosis is not yet clear, additional studies may be appropriate. Percutaneous electromyography (E.M.G.) can provide additional information about muscle activity and innervation of laryngeal muscles. In the case of a vocal cord paralysis this also gives prognostic information. Radiological examinations (eg RX of the lungs or CT neck) can demonstrate a local cause of vocal cord paralysis.
Laryngostroboscopy left vocal cord polyp
Smoker's polyps
THERAPY
It goes without saying that a correct diagnosis is paramount for a successful treatment. The treatments can be very diverse. If incorrect use of the voice or voice abuse is the cause, a speech therapy treatment will often be proposed. Rarely, a drug treatment can offer the solution such as when reflux of acidic stomach contents lies at the basis of irritation of the vocal cords. Surgical treatments, whether or not in combination with speech therapy, may be appropriate for vocal swelling, small malignant tumors (laser excision) or, for example, vocal cord polyps in smokers. Even when one or both vocal chords are paralyzed, resulting in severe hoarseness and often swallowing problems, effective treatment can be provided. ('Thyroplasty')
Sometimes there is a problem with the control of the vocal cords. This leads to characteristic voice problems recognisable by listening carefully to the voice. Injections into the incorrectly tuned vocal cord muscles are performed for these disorders. This is done together with another doctor who measures the electrical activity of the punctured muscles synchronously and is performed on the consultation.
Such and other treatments can often greatly improve the quality of life and communication possibilities of patients. Unfortunately, hoarseness is too often not regarded as a real problem, also among doctors. Or they are satisfied with the exclusion of a tumor from a smoker, for example. However, every patient with hoarseness deserves expert examination and the resulting treatment will almost always be able to solve the problem.