The next day, Tony joined a Bloody Mary brunch with the gang. Only he wasn’t as talkative as the day before. His voice was a lot deeper, and he could barely get the pitch up to a point where he could be heard in the noisy restaurant.
Welcome to the club, Tony. You’re now part of the hoarse set, which is quite different from the horsey set at the country clubs.
Everyone experiences a hoarse voice on occasion. Whether it’s caused by overuse, like Tony’s yelling at a sports event, or arrives with a cold or some other issue with the voice box, it typically creeps in without much notice and departs just as quickly.
Most hoarseness is a minor issue. However, some hoarseness may be an indication of other, more serious problems than shouting too much at a football game. The problems can range from allergies to cancer, and if hoarseness extends for more than a few days, then a doctor should examine the condition.
How We Speak
A human speaking voice is determined when air from the lungs is pushed out through the vocal cords in the voice box. Those cords consist of mucous membranes in two folds that cover local muscles surrounded by cartilage. When air passes over the cords, they vibrate and produce the sounds that allow humans to speak.
When someone gets laryngitis (defined as swelling and inflammation of the cords), a hoarse voice ensues. Most laryngitis comes from respiratory infections.
Clinically, hoarseness is difficulty in making sounds when trying to speak or while speaking. The voice may be scratchy, breathy, husky or pitchy, and voice quality can change.
Most hoarseness is caused by a problem related to the vocal cords. The cords are part of the voice box (formally, the larynx) located in the throat. If the cords are infected or inflamed, they swell, producing hoarseness.
Many Causes of Hoarseness
The most common issue that causes hoarseness is a sinus infection or cold. These usually go away with over-the-counter medications within two weeks. But other issues that can cause hoarseness include allergies, acid reflux, breathing in substances that irritate the vocal cords, upper respiratory infections, chronic coughs, heavy smoking, excessive drinking (which can cause a double knockout if combined with smoking), excessive shouting or singing, and cancer of the throat or larynx. There also may be benign vocal cord nodules, cysts or polyps present or neurological issues such as a stroke or Parkinson’s disease that can cause hoarseness.
In addition to the above, rarer instances that may cause hoarseness include damage to the muscles and nerves that surround the voice box, typically from surgery or some trauma; a foreign object lodged in the trachea or esophagus; swallowing a harsh chemical or liquid; irritation or injury caused by a breathing tube or bronchoscopy; thyroid or lung cancer; an underactive thyroid gland; and changes wrought by puberty in the larynx.
Here are some other issues that may be the source of the hoarse voice:
1) Age – As we get older, vocal cords can lose some fullness and tension. It’s why older singers have trouble staying on pitch, even if they were brilliant in their younger years. The voice can warble or become hoarse, and depending on whether the ability to talk is affected, surgery may be needed. During the surgery, doctors will inject medications that can add fullness and bulk to vocal cords frayed by years of use.
2) Cancer of the larynx – If the patient is older than 60, a former or current smoker, a heavy drinker and someone in generally poor health, cancer can develop. With early detection, surgery can remove much of the offending material without radiation treatments.
3) Underlying issues – The thyroid gland is located in proximity to the vocal cords, and surgery on that gland often results in temporary or permanent damage to the vocal cords. Other conditions also can affect the voice, including rheumatoid arthritis, hypothyroidism, Parkinson’s disease, stroke and multiple sclerosis.
4) Vocal cord spasms – Some vocal cord muscles develop spasms. These can place the vocal cords under tension, altering the voice. An injection of botulinum toxin (Botox) can paralyze the muscle undergoing spasms. However, the injection will wear off and may need to be repeated if spasms and hoarseness return.
Time Heals Most Hoarseness
Most hoarseness goes away on its own with rest and time. But if it continues for weeks or months, it’s time to see a doctor for a complete history and physical. Before seeing the doctor, symptoms may be eased by limiting conversation; drinking plenty of fluids to moisten the airways; using a vaporizer to add moisture to the air; avoiding singing, crying, shouting or even whispering; taking over-the-counter medications to reduce stomach acid; avoiding use of decongestants, which often dry out the vocal cords; and cutting back on or eliminating smoking.
There may be times when hoarseness morphs into something far worse, including trouble breathing or swallowing; hoarseness accompanied by drooling (particularly in very young children); hoarseness in a child under three months old; and hoarseness lasting more than a week in a child.
Doctors usually check the throat, neck and mouth to determine what may cause excessive hoarseness and will ask about recent history and any other symptoms, like sudden weight loss.
In some cases, the doctor may take a throat culture, which will be laboratory analyzed, or a laryngoscopy, which uses a tube to examine what’s going on down in the less visible areas of the throat. Doctors may request a blood test to rule out other issues or take X-rays or a CT scan of the neck.
Depending on the cause of the issue, there are several options, ranging from the conservative to the surgery.
Acute laryngitis will usually disappear on its own once the infectious cause is no longer present. Cough suppressants, over-the-counter medications and rest will usually suffice to help clear the issue. Humidifiers and voice rest are also good ideas. Antibiotics are not used for most issues related to hoarseness and should not be taken because they will not help cure the cause of hoarseness.
For smokers, cutting back or eliminating the habit is a good idea to help speed along a voice cure.
If the hoarse voice is related to nodules, polyps or trauma to the larynx and vocal cords or is caused by cancer, then surgery to remove the offending tumors will be recommended. This is a serious and delicate surgery, and recovery times vary. There may, in some instances, be permanent damage to the vocal cords resulting from the surgery or cancer.
But in most cases, rest and perhaps warm beverages can bring most voices back. After all, as Tony knows, it’s a long haul. There are 16 games in a season and more in the playoffs.