Is Hoarseness a Sign of a More Serious Condition?


By Nitinkumar Patel, MD

Whether as the result of a bad cold or too much cheering at a football game, nearly everyone has experienced a bout of hoarseness at some point in their lives.

The condition affects one of 13 American adults every year, according to the American Association of Otolaryngology – Head and Neck Surgery, and kids can also have episodes of being hoarse. Not only is hoarseness prevalent, it can be costly. It’s the reason for many trips to the doctor as well as billions of dollars in lost productivity when people have to miss work over it.

Defined simply as altered voice quality, the clinical term for hoarseness is dysphonia. The voice might sound strained, weak, or raspy, and the pitch or volume might also be altered. More of a symptom than its own disease, dysphonia has a number of underlying causes.

Fortunately, most episodes of hoarseness resolve on their own in a matter of days. But hoarseness can also indicate a more serious condition requiring treatment.

The issue for physicians is knowing when to escalate care. In March 2018, the American Association of Otolaryngology – Head and Neck Surgery issued a revised set of evidence-based guidelines on when physicians should accelerate diagnosis and treatment of hoarseness. The new guidelines were established to help address serious conditions more quickly and standardize care across providers. They can also help you know when to see a doctor if you’re hoarse, and what to expect. Below is some more detailed information on getting the proper diagnosis and treatment for this condition.

What Causes Hoarseness?

The voice is produced by the vibration of the vocal cords, two bands of muscle in the larynx, or voice box. The most common cause of hoarseness is laryngitis, which is swelling and inflammation of the vocal cords. Laryngitis is often caused by excessive talking, coughing, yelling, or singing. Coaches, teachers, professional singers and actors, and other people who are likely to overuse their voices are especially prone to straining their vocal cords and becoming hoarse. Upper respiratory tract infections, including the common cold, are another common cause of laryngitis, as are smoking, second-hand smoke, and allergies. Even acid reflux, also known as heartburn, can result in hoarseness, because the stomach acid that backs up into the esophagus can reach the vocal cords.

Less common, more serious causes of hoarseness include head and neck cancers, neurological disorders that cause tremors, such as Parkinson’s disease, autoimmune conditions such as rheumatoid arthritis, nerve damage resulting from diabetes, and complications from the use of a breathing tube or a prior surgery near the larynx.

When to Seek Medical Attention for Hoarseness

If your hoarseness does not go away within 10 days, you should see your doctor. Also see a physician if your hoarseness is not accompanied by a cold or the flu, if you are having trouble swallowing or breathing, if speaking or swallowing hurts, if you feel a mass in your neck, or if you cough up blood. It’s also a good idea to get checked out by a professional if the change in your voice seems severe, or you lose your voice completely.

Diagnosing and Treating Hoarseness

In the past, physicians often treated cases of hoarseness without having a true diagnosis. They started patients on medications for potential causes, often prescribing antibiotics, steroids, and anti-reflux drugs. But studies have shown that this approach was often not effective, and by medicating patients with drugs they did not need – and sometimes delaying the diagnosis of a more serious condition such as cancer – it ultimately did more harm than good.

The new guidelines advise doctors to examine patients with hoarseness by looking more closely for signs of a potentially serious condition. If you are hoarse and see your doctor, she should take your medical history and conduct an examination to determine if you have had a prior surgery of the head, neck, or chest that might be altering your voice; if you are a smoker or have respiratory problems; or if you have a mass in your neck area. If your physician finds anything that could indicate an underlying disease, the guidelines recommend a referral to an otolaryngologist who can conduct a laryngoscopy to visualize the larynx and vocal cords – which involves using a small scope to view the back of the throat and the voice box. It can be conducted right in the doctor’s office and takes just a few minutes.

Laryngoscopy is now also recommended for any instance of hoarseness that does not clear up on its own within four weeks, much sooner than the 90-day window recommended in earlier guidelines.

How your physician treats your hoarseness obviously depends on the diagnosis. The difference under the new guidelines is that an accurate diagnosis should be determined before treatment begins. For the most part, anti-reflux medications as well as steroids and antibiotics should be not prescribed until after a laryngoscopy indicates that they would be effective. Most hoarseness can be treated simply by resting the voice. Head and neck cancers are likely to be treated surgically.

A Word about Prevention

Of course, one way to “treat” hoarseness is to prevent it from happening in the first place. There are steps you can follow to take care of your voice, which is especially important if you are in a profession that requires you to use your voice a lot. Avoid yelling as best you can, and allow your voice to guide you: If it feels or sounds strained, let it rest. If you smoke, quit, and stay out of smoky places. If you have acid reflux, treat it, and avoid eating too much dairy and starch, which cause you to produce more mucous, which can make you hoarser. Remember that spicy foods, alcohol, and caffeine are dehydrating and can irritate the voice. Drink plenty of water and humidify your home. If you speak publicly, use a microphone when one is available.

Remember that most hoarseness can be treated, as well as prevented, simply by not abusing your voice. To learn more about improving your total health, visit MAPMG’s Staying Healthy pages.

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