Hoarseness is a common term used by most people to describe changes in the voice that make it sound abnormal. When a voice is not normal, it is said to be "hoarse". Actually, there are many types of hoarseness or voice quality changes that if left untreated will limit one's ability to communicate effectively, cause a loss of income or lead to serious medical conditions. Hoarseness (the technical term is dysphonia) has many causes and is only a sign that a problem exists with the vocal folds, the muscular structures that vibrate to produce sound for speech and singing.

How is the voice produced?

The vocal folds (vocal cords) are housed inside the larynx, the structure in the neck easily identified by the prominent "Adam's apple." The vocal folds lie right behind the Adam's apple. The vocal folds produce sound when they come together and are driven by the air supply from the lungs. In order for sound to be clear and not hoarse, the vocal folds must move together symmetrically, be capable of opening and closing regularly and then have sufficient air flow from the lungs to keep them vibrating. The vocal folds are capable of vibrating at speeds as low as 10 times a second all the way to 1200 times a second, as in a soprano singing a high note. However, when the voice is hoarse, the vocal folds may fail to close, fail to vibrate symmetrically or fail to maintain vibration at a steady rate.


How are voice problems diagnosed?

A comprehensive evaluation of hoarseness includes a detailed history or voice usasge and an examination of the larynx and the vocal folds. The details surrounding the onset of the problem are particularly important. How, when, where and under what conditions did the problem begin? The evaluation of hoarseness includes a perceptual assessment of voice quality - pitch, loudness, pitch breaks or other changes from the normal voice. Instrumental assessment of the voice including measurement of pitch and loudness range, and clarity (called perturbation) is an important part of the evaluation.

How are the vocal folds examined?

Visual examination of the vocal folds is the key to a comprehensive evaluation of hoarseness. The examination of the vocal folds may be done with a flexible endoscope that passes through the nose or a rigid endoscope that shines a light onto the vocal folds from the mouth. Video strobolaryngoscopy is a special examination technique that uses a special light and microphone to synchronize the movements of the vocal folds so they may be viewed in slow motion. The details of vibration and vocal fold motion are recorded for review and permanent record. Examinations are routinely conducted in the office and take only a few minutes.

How is hoarseness treated?

Treatments of hoarseness may include medications, voice therapy, surgery or all of these. Voice therapy is a behavioral technique that consists of vocal hygiene, a daily plan for avoiding voice misuse, strain and over use, Voice therapy also consists of vocal exercises, respiratory support management and vocal relaxation. Voice therapy is used to return the voice to its highest and best use after injury or surgery. Voice therapy is the treatment of choice for many voice disorders. Voice therapy is conducted by a certified and licensed speech-language pathologist after vocal fold examination. Comprehensive care of hoarseness may also require surgery if changes are not responsive to voice therapy or medications.



When to get help?

Hoarseness which lasts for two weeks or more requires a comprehensive diagnosis and treatment to prevent further injury or damage to the voice and return the voice to normal use.