Dr. Hazenfield -- Ear, Nose, and Throat Doctor in Hawaii

Voices Problems

Hugh N. Hazenfield, M.D., F.A.C.S.

The Normal Larynx

(Voice Box)

Anterior

(Front)

^{Left side       Right side}

Posterior

(Back)

You may view a short video of a normal larynx by clicking the next picture of a larynx.  It is "upside down" from the picture above.  (Even with broadband, it takes a short length of time for the video to download.)

Posterior

(Back)

Right    Left

Anterior

(Front)

Hoarseness

• What is hoarseness?

   

  • Hoarseness is a general term that describes abnormal voice changes.

  • When hoarse, the voice may sound breathy, raspy, strained, or there may be changes in volume (loudness) or pitch (how high or low the voice is).

  • The changes in sound are usually due to disorders related to the vocal folds that are the sound producing parts of the voice box (larynx).

  • While breathing, the vocal folds remain apart. When speaking or singing, they come together, and as air leaves the lungs, they vibrate, producing sound.  The more tightly the vocal folds are held and the smaller the vocal folds, the more rapidly they vibrate. More rapid vibration makes a higher voice pitch.

  • Swelling or growths on the vocal folds or swelling in the back of the voice box prevent them from coming together properly, which makes a change in the voice.

   

• Causes of hoarseness:

   

  • There are many causes of hoarseness. Fortunately, most are not serious and tend to go away in a short period of time. 

   

  • Common causes of brief hoarseness:

     

    • Acute laryngitis, which usually occurs due to swelling from a common cold, upper respiratory tract viral infection

    • Irritation caused by excessive voice use such as screaming at a sporting event or rock concert.

     

  • Common causes of prolonged hoarseness:

     

    • Voice abuse over extended periods of time.

    • Vocal nodules (singers nodes), which are callous-like growths, or may lead to polyps of the vocal folds (more extensive swelling).  Vocal nodules are common in children and adults who raise their voice in work or play.  Uncommonly, polyps or nodules may lead to cancer.

     

    

    Vocal Nodules

     

     

     

    • Laryngopharyngeal Reflux (LPR), Gastroesophageal Reflux (GERD), or Acid Reflux:

     

    

     

    LPR:  Thickening of posterior commissure and

    swelling of the vocal cords

     

    • Acid reflux:  Stomach acid comes up the esophagus (swallowing tube), irritating the back part of the voice box

    • Most patients with reflux-related changes of the voice do NOT have heartburn.

    • Usually, the voice is worse in the morning and improves during the day.

    • These people may have a sensation of a lump in their throat, mucous sticking in their throat that they cannot cough out, an excessive desire to clear their throat, or have a bitter taste.

    • For more information, go to this page:

    Reflux Disease

     

    • Smoking is another cause of hoarseness. 

      • Smoking may just cause irritation and swelling of the vocal cords.

      • Smoking is the major cause of throat cancer.  If smokers have hoarseness for more than 5-7 days, they should see an otolaryngologist.  

     

    • Cancer of the larynx, throat, or lung

      • This is a picture of a carcinoma (cancer) of the left vocal cord:

      

      Cancer of the left vocal cord

       

      • Cancer of the throat can change the voice

      • Cancer of the lung can cause paralysis of a vocal cord

   

• Other causes of hoarseness:

• Allergies

• Thyroid problems

• Neurological disorders

• Trauma to the voice box

• Occasionally, the normal menstrual cycle

• Presbylaryngis or presbylarynx

With advancing age, our vocal cords become thin, and we may develop weakness and hoarseness of our voices.

 

• Treatment:

Seek treatment if:

• Hoarseness that lasts longer than 5-7 days;

• Hoarseness associated with any of the following:

  • Pain in the throat not from a cold or flu

  • Bitter taste

  • Persistent cough, especially if dry

  • Lump sensation in the lower throat

  • Pain in the ear

  • Coughing up blood

  • Difficulty swallowing

  • Palpable lump in the neck

   

• Speech/language pathologists, and teachers of singing, acting, or public speaking as well as the otolaryngologist may be required to treat voice disorders.

• How Is Hoarseness Evaluated?

• An otolaryngologist will obtain a thorough history of the hoarseness and your general health.  (If you use your voice professionally, you may be required to complete a relatively long questionnaire.)

• Your doctor will usually look at the vocal folds with a mirror placed in the back of your throat or with a very small lighted flexible tube (fiberoptic scope) passed through your nose (after numbing it) in order to view your vocal folds. 

• Strobovideolaryngoscopy (videotaping in slow motion) may be required to fully assess the cause of your hoarseness.  

• These procedures usually are not uncomfortable and are well tolerated by most patients.

• How Are Vocal Disorders Treated? 

  • The treatment of hoarseness depends on the cause. 

  • Many cases of  hoarseness can be treated by simply resting the voice or modifying how it is used. 

  • The otolaryngologist may make some recommendations about voice use behavior, refer the patient to other voice team members, and in some instances recommend surgery if a lesion, such as a nodule or polyp, is identified. 

  • Avoidance of smoking or exposure to secondhand smoke (passive smoking) is recommended to all patients. 

  • Drinking relatively large quantities of fluids is also helpful.  

  • Behavior modification that may help eliminate some voice disorders.  Sometimes, patients have developed bad habits, such as smoking or overuse of their voice by yelling and screaming.  

  • The speech/language pathologist may teach patients to alter their method of speech production to improve the sound of the voice and to resolve problems, such as vocal nodules. 

  • When a patient's problem is specifically related to singing, a singing teacher may help improve the patients' singing techniques.  

• Avoid the following to keep your voice healthy:

   

  • Smoking (tobacco, marijuana, and other recreational drugs)

  • Smoke

  • Dry air

  • Dust

  • To avoid reflux of stomach contents into your throat, with a resultant acid burn of your larynx (laryngopharyngeal reflux, or LPR), avoid the following:

    • Alcohol, other than in moderation

    • Caffeine (over 3 beverages per day and only in the morning); it dehydrates your body

    • Carbonated beverages

    • Chocolate; it contains caffeine

    • Mints

    • Spicy foods

    • Acid foods, such as tomatoes or citrus fruits

    • Going to bed within three hours of eating or drinking anything, including water (it takes at least 3 hours for the stomach to empty)

•  Use the following to keep your voice healthy:

   

  • Water and juice -- 8 to 10 glasses per day (even more in a warm climate)

  • A voice coach if you use your voice professionally

  • A humidifier in a heated house or apartment; but, clean it weekly with a mild bleach solution to avoid mold growth

  • New air conditioner filters every two months (or clean the filters well)

  • An air filter if your house or apartment is enclosed  (This is of little benefit in Hawaii, since most of us have our homes open to the outside.)

  • A filtering mask if exposed to dust or other particulate matter

• Warning signs that there may be a problem with your voice include the following:

   

  • Hoarseness

  • Aphonia (No voice at all)

  • "Jerky" voice (spasms)

  • Lump sensation near your Adam's apple

  • Pain near your Adam's apple

  • Bitter taste

  • Coughing blood

  • Chronic cough

  • Pain in the ear

If any of these warning signs occur, consult your physician or an otolaryngologist (ear, nose and throat doctor).

 

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My offices are in the following convenient locations:

• Aiea (also serving Honolulu & Waipahu)

• Wahiawa (also serving Mililani & the North Shore)

For appointments call:  (808) 622-2626

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