Keeping Your Voice - Hoarseness and When to See a Doctor

Keeping Your Voice - Hoarseness and When to See a Doctor

We have all experienced problems with our voices, times when the voice is hoarse or when sound will not come out at all! Colds, allergies, bronchitis, exposure to irritants such as ammonia, or cheering for your favorite sports team can result in a loss of voice. In observance of World Voice Day, find out how NCEENT Speech-Language Pathologists help patients keep their voice.

If you have experienced a hoarse voice for more than 2 to 3 weeks, you should see a physician. A thorough voice evaluation should include: a physician's examination, preferably by a NCEENT Otolaryngologist (ear, nose, and throat doctor) who specializes in voice, followed by a voice evaluation by a speech-language pathologist (SLP).

What causes hoarseness?

Hoarseness is most often caused by a problem with the function of the vocal cords, which are part of your voice box (larynx) in the throat. When the vocal cords become inflamed or infected, they swell. This can cause hoarseness, as can local mucosal or muscular problems.

Dysphonia is a similar concept that rather refers to the actual production of sounds but is sometimes used by clinicians as a synonym to hoarseness. Some terms which may be used to describe a voice change are: breathy, harsh, tremulous, weak, reduced to a whisper, unstable (diplophonic or with frequent register breaks).

Vocal fatigue means that the voice tires abnormally easy which may lead to vocal discomfort and hoarseness.

Risk Factors For Voice Problems

  • Smoking (also the main risk factor for laryngeal carcinoma)
  • Excess alcohol consumption
  • Gastro-esophageal reflux
  • Professional voice use – eg, teachers, actors and singers
  • Environment: poor acoustics, atmospheric irritants and low humidity
  • Type 2 diabetes (neuropathy, poor glycaemic control).

Treatment for Voice Problems

Voice therapy has been demonstrated to be effective for hoarseness across the lifespan from children to older adults (Ramig & Verdolini, 1998; Thomas & Stemple, 2007).  This therapy has been used to treat hoarseness concurrently with other medical therapies like botulinum toxin injections (botox) for spasmodic dysphonia and/or tremor (American Academy of Otolaryngology-Head and Neck Surgery, 2005; Murry & Woodson, 1995; Pearson & Sapienza, 2003).

What Happens In Voice Therapy?

Voice therapy is a program designed to reduce hoarseness through guided change in vocal behaviors and lifestyle changes. Voice therapy consists of a variety of tasks designed to eliminate harmful vocal behavior, shape healthy vocal behavior, and assist in vocal fold wound healing after surgery or injury. Voice therapy for hoarseness generally consists of one to two therapy sessions each week for 4–8 weeks (Hapner et al., 2009). The duration of therapy is determined by the origin of the hoarseness and severity of the problem, co-occurring medical therapy, and, importantly, patient commitment to the practice and generalization of new vocal behaviors outside the therapy session (Behrman, 2006).

Tips For Keeping Your Voice Healthy

  • Avoid talking over noise (at parties, restaurants, etc.), as this fatigues the voice.  At parties, use an ear plug in one ear - this will allow you to hear yourself over the noise, so you won't use such a loud voice
  • Use amplification for public speaking
  • Never scream
  • Avoid whispering. Loud whispering causes vocal strain
  • Avoid grunting with heavy exercise
  • Avoid coughing or heavy throat clearing. Instead swallow your saliva, take a sip of water or do a silent cough simply pushing air through your vocal folds ( as if saying h) to loosen the mucous so you can swallow
  • If your voice sounds abnormal or if you have laryngitis, rest your voice periodically and avoid unnecessary talking.
  • If your voice feels tired or strained, rest it
  • Your vocal folds work best when they are hydrated. Drink 6-8 glasses of water a day and limit your intake of caffeinated and alcoholic beverages
  • Talk to your doctor about treating acid reflux (through diet modification or medication) as this can irritate the vocal folds and lead to hoarseness
  • Avoid smoking or breathing second hand smoke

Questions? Schedule an evaluation with a NCEENT speech-language pathologist at 919-595-2000.