Any worsening of voice quality is usually described as hoarseness. Because of the frequency with which most people use their voices, hoarseness is noticed very quickly by most patients.
The commonest causes of hoarseness are:
1. Voice abuse This is often the case in children. In the playground or when playing sports children naturally shout. In some children this can, if excessive, lead to inflammation of the vocal cords and small areas of thickening which are called vocal cord nodules. This leads to a gradually worsening voice quality and singing also suffers. Once diagnosed the usual treatment is voice rest, speech therapy and if needed, treatment for reflux.
In adults voice abuse can lead to temporary hoarseness eg. in football or rugby supporters after a particularly exciting match. If the pattern is continued regularly and often, the hoarseness can become permanent – particularly when coupled with one or more of the factors described below. Treatment depends upon accurate diagnosis.
2. Smoking As we age our tissues turn over more slowly and so are exposed to more insults. Although young adults may seem to cope well with irritants in smoke, as we age this coping ability decreases. This together with the changes in the lining of the airway caused by smoking means that the airway is less efficient at removing irritants and carcinogens, and produces thickened mucus. In addition, the vocal cords are bathed in a flow of smoke as air passes both inwards and outwards. Any insult therefore- be it caused by virus, trauma, or acid- is slower to heal. It can be likened to a cut on the hand which instead of being covered and left alone, is scratched daily. The long term result of this is chronic inflammation and worsening voice quality. There is of course a significant risk in smokers that voice change not only indicates inflammation but cancerous changes. Treatment depends upon what is seen at laryngoscopy.
3. Reflux Acid reflux can cause immense damage to the lining of the throat (pharynx) and voicebox (larynx). It becomes more frequent as we age. The tube (oesophagus) from the throat to the stomach is lined by a tough epithelium and can tolerate a lot of acid before producing symptoms of heartburn. The vocal cords however are designed to be exquisitely sensitive. They have to be as they protect the airway – the most essential system to maintain life. This mismatch in sensitivity means that although a patient may suffer no heartburn, a small amount of acid refluxing up the oesophagus can cause significant inflammation if it lands on the vocal cords. There is also an enzyme produced in the stomach called pepsinogen. This tends to travel up the oesophagus whenever air is released in a belch. It clings to the lining of the throat and vocal cords and when activated produces damage which again results in inflammation. An accurate diagnosis relies upon taking a good history and endoscopic examination of the vocal cords. Treatment is with medications and is usually very effective.
Less frequent symptoms accompanying hoarseness are:
- Coughing blood
- Pain (in the larynx or felt in the ear)
- Difficulty swallowing food, and weight loss.
If any of these symptoms are present an urgent assessment should be sought.
If you would like to arrange a consultation with Mr Banerjee to look into this condition further please contact us.