Frequently Asked Questions
What is Hoarseness?
Dysphonia, or impaired voice production, is sometimes called “hoarseness.” Dysphonia describes your impaired voice production. Hoarseness is a symptom of a change in your voice quality. Health care providers will use the clinical term dysphonia, but patients and the public use the more common term hoarseness.
Dysphonia is very common. It affects nearly one-third of the population at some point in their lives. Dysphonia is characterized by a change in voice quality, pitch (how high or low the voice is), volume (loudness), or vocal effort that makes it difficult to communicate as judged by a health care provider, and it may affect your quality of life.
The symptom of hoarseness is related to problems in the sound-producing parts (vocal cords or folds) of the voice box or larynx. Your voice may have a raspy, weak, or airy quality that makes it hard for you to make smooth vocal sounds.
Dysphonia is very common. It affects nearly one-third of the population at some point in their lives. Dysphonia is characterized by a change in voice quality, pitch (how high or low the voice is), volume (loudness), or vocal effort that makes it difficult to communicate as judged by a health care provider, and it may affect your quality of life.
The symptom of hoarseness is related to problems in the sound-producing parts (vocal cords or folds) of the voice box or larynx. Your voice may have a raspy, weak, or airy quality that makes it hard for you to make smooth vocal sounds.
What causes hoarseness?
Dysphonia is a symptom common to many diseases. Most dysphonia (hoarseness) is related to upper respiratory tract infection and goes away on its own in 7 to 10 days. You may have a serious medical condition that requires further evaluation by a Laryngologist (voice specialist). The most common causes of hoarseness are:
- Common cold, upper respiratory tract infection
- Voice overuse leading to muscle tension
- Voice overuse leading to phonotraumatic lesions (polyps, cysts, nodules)
- Acid reflux
- Autoimmune disease
- Allergic laryngitis (inflammation of the larynx due to allergies)
- Smoking and secondhand smoke
- Head and neck cancer
- Medication side effects
- Age-related changes
- Neurological conditions (examples: Parkinson’s disease, amyotrophic lateral sclerosis)
- Intubation (process of inserting a tube through the mouth and into the airway)
- Postsurgical injury (particularly following chest or neck procedures)
When should I see a voice specialist about hoarseness?
- Your hoarseness does not go away or get better in 7 to 10 days, especially if you smoke
- You do not have a cold or flu
- You are coughing up blood
- You have difficulty swallowing
- You feel a lump in your neck
- You observe loss or severe changes in your voice that last longer than a few days
- You experience pain when speaking or swallowing
- Your voice change comes with uneasy breathing or noisy breathing
- Your hoarseness makes your work hard to do
- You are a vocal performer (singer, teacher, lawyer, public speaker) and cannot do your job
Reference: Stachler RJ et al., Clinical Practice Guidelines: Hoarseness (Dysphonia) (update). Otolaryngol Head Neck Surg. 2018 Mar;158(1_suppl):S1-S42. doi: 10.1177/0194599817751030.
Who is at risk?
Dysphonia affects patients of all ages and sexes but is more common in people who use their voice frequently. Singers, teachers, lawyers, sales personnel, and call-center operators are some examples. People who smoke are also more likely to develop dysphonia due to laryngeal swelling or vocal cord cancers.
Recently, studies have noted an increasing amount of vocal cord cancers diagnosed in patients who have never smoke or drank. The human papillomavirus (HPV) may be playing a role in these patients, but the disease is evolving beyond smokers.
References: Bayan, S et al. Glottic Carcinoma in Young Patients. Ann Otol Rhinol Laryngol. 2019 Mar;128(3_suppl):25S-32S. doi: 10.1177/0003489418818852
Zeitels, SM et al., Glottic Cancer: A Metamorphosing Disease. Ann Otol Rhinol Laryngol. 2016 Jun;125(6):452-6. doi: 10.1177/0003489415619177. Epub 2015 Nov 26
Recently, studies have noted an increasing amount of vocal cord cancers diagnosed in patients who have never smoke or drank. The human papillomavirus (HPV) may be playing a role in these patients, but the disease is evolving beyond smokers.
References: Bayan, S et al. Glottic Carcinoma in Young Patients. Ann Otol Rhinol Laryngol. 2019 Mar;128(3_suppl):25S-32S. doi: 10.1177/0003489418818852
Zeitels, SM et al., Glottic Cancer: A Metamorphosing Disease. Ann Otol Rhinol Laryngol. 2016 Jun;125(6):452-6. doi: 10.1177/0003489415619177. Epub 2015 Nov 26
How is Hoarseness Diagnosed?
A comprehensive history and physical exam will be performed. If indicated, a videostroboscopy will then be performed to better evaluate your voice box (larynx). A videostroboscopy is a state-of-the-art technology which facilitates the identification of various vocal cord conditions and abnormalities. It provides a magnified view of the larynx, and simulates slow-motion vibration of the vocal cords. This procedure is the gold-standard in laryngological diagnostic care. At Kentuckiana ENT, we are happy to be one of the only facilities in the state to offer this technology. Depending on the findings from the stroboscopy, a diagnosis and treatment can be determined right away. Further evaluation with laboratory studies, swallow studies, or CT scans may also be indicated.
I have had a previous laryngoscopy to evaluate hoarseness in the past that was normal. Is there a more focused exam I should obtain?
If you have had a previous office laryngoscopy that was normal, but still have concerns, you can be seen for a videostroboscopy. Although reflux is a common diagnosis for hoarseness, many patients are given this diagnosis when there are other etiologies of their hoarseness identified on videostroboscopy. A stroboscopy exam can not only identify vocal cord lesions, it can also assess for stiffness of vocal folds, indicative of scar or loss of pliability related to phonotrauma. There are also voice disorders related to coordination of laryngeal muscles that may only be identified by a formally trained laryngologist.
Reference: Cohen, SM et al., Change in Diagnosis and treatment following specialty voice evaluation: A national database analysis. Laryngoscope. 2015 Jul;125(7):1660-6. doi: 10.1002/lary.25192. Epub 2015 Feb 13.
Reference: Cohen, SM et al., Change in Diagnosis and treatment following specialty voice evaluation: A national database analysis. Laryngoscope. 2015 Jul;125(7):1660-6. doi: 10.1002/lary.25192. Epub 2015 Feb 13.
What does a videostroboscopy entail?
A videostroboscopy can be performed with either a rigid or flexible laryngoscope.
If a rigid laryngoscope is used, a thin metal camera is placed on your tongue. The rod uses a 70 degree camera to view your vocal cords. A topical numbing spray (cetacaine) is sometimes used prior to laryngoscopy.
If a flexible laryngoscope is used, Dr. Burckardt will apply a topical numbing (4% lidocaine) and decongestant (phenylephrine) spray into your nose. The flexible laryngoscope is then passed through one nasal passage to view the vocal cords.
During the laryngoscopy, you will be asked to perform a variety of vocal tasks in order to better understand the mechanics of your vocal cords. The procedure is not painful and generally lasts less than 1 minute. No sedation is required.
I am a professional or student vocalist. What is important for me to know?
The health of your vocal cords is our number one priority. Many voice professionals and students will visit our office for an annual stroboscopy and checkup. It is important for us to have a baseline understanding of the condition of your vocal cords. If you develop voice problems later, we will be able to compare the exams to determine if there has been any structural change. We can also discuss vocal health and hygiene and help you to meet your vocal needs more appropriately.
If you are a professional voice user struggling to meet your vocal needs in anyway - we can help. Whether it's the quality of your voice, recurrent vocal fatigue, or pain when speaking, we can perform a thorough evaluation and offer solutions for your specific problem.
If you are a professional voice user struggling to meet your vocal needs in anyway - we can help. Whether it's the quality of your voice, recurrent vocal fatigue, or pain when speaking, we can perform a thorough evaluation and offer solutions for your specific problem.
What are the most common treatments for voice disorders?
The treatment of hoarseness depends on the cause.
We are happy to provide all of the above treatment options at Kentuckiana ENT. Dr. Burckardt will discuss treatment options that are best suited for you once a diagnosis has been made.
- Some cases can be managed with appropriate vocal hygiene including hydration, rest, reflux, and allergy optimization
- Some cases will require voice therapy
- Some circumstances will require phonomicrosurgery, laser, or larygneal frameworks surgery
- Some neurological conditions require Botox injection (botulinum toxin) into the vocal folds
- Some conditions will require injection of fillers into the vocal folds
We are happy to provide all of the above treatment options at Kentuckiana ENT. Dr. Burckardt will discuss treatment options that are best suited for you once a diagnosis has been made.
