Hoarse Voice (Dysphonia)

Dysphonia can be sub-divided into acute and chronic (including intermittent):

Acute dysphonia –

Usually the result of a viral throat infection or over-use (such as persistent shouting). This is called laryngitis (literally; “inflammation of the larynx”) and may occasionally be secondary to an allergy such as Hay Fever.

Acute laryngitis is self-limiting and resolves with rest and symptomatic treatment over a week or two.

Chronic dysphonia –

More complex since it can have multiple causes:

A. Inflammatory – Including:

• acid reflux from the stomach causing swelling & irritation of the vocal cords
• post-nasal drip from chronic allergy causing irritation and inflammation of the vocal cords.

B. Local growths – Including:

• vocal cord nodules, polyps, cysts and papillomas. Most of these growths are benign in nature however, throat cancer needs to be excluded as a potential cause of chronic dysphonia.

A diagnosis of laryngeal cancer is more likely where there is a history of smoking or alcohol excess and where symptoms include:

• Pain when swallowing or difficulty swallowing (dysphagia).
• A lump or swelling in your neck.
  
• Chronic cough.
  
• Persistent sore throat or earache (otalgia).
  
• Difficult/noisy breathing (stridor).
  
• Unexplained weight loss, or fatigue (extreme tiredness).

These symptoms are known as “red flag” symptoms.

C. Scarring of the vocal cords:

• Local scarring can occur as a result of injury to the larynx such as after intubation during surgery.

D. Paralysis of the vocal cords

• This may be congenital or result from neurological conditions such as stroke and Multiple Sclerosis

E. Muscle Tension Dysphonia (MTD)

• a group of voice disorders that develop as a result of the way in which the voice is habitually used. This problem has been given many other names and classifications in the past including ‘Functional Dysphonia,’ ‘Vocal Hyperfunction’, ‘Muscle Misuse Dysphonia’ and ‘Muscle Imbalance Dysphonia’. These conditions are associated with inappropriate muscle use within the larynx during voicing. Although normally MTD is associated with constriction and too much muscle effort (hyperfunction), it can also apply to vocal postures where there appears to be too little muscle effort in the vocal folds causing weakness and bowing (hypofunction). In these cases, the excess muscular effort is occurring in other, less effective muscles in and around the larynx.

Dysphonia can often be prevented:

• Do not excessively clear your throat.
• Avoid agents that dehydrate the body.
• Avoid dry environments.
• Avoid smoking.
• Rest properly.
• Humidify your home.
• Avoid excessive spicy food and alcohol.
• Try not to force your voice or use it for too long or too loudly.

Intermittent mild episodes of hoarseness will, in most cases, settle by themselves. To help relieve the symptoms one can:

• rest the voice (but do not resort to whispering which can make matters worse).
• drink plenty of fluids (avoid too many fizzy drinks).
• avoid alcohol.
• avoid cigarette smoke.
• take Antacids e.g., Gaviscon if you get a build-up of acid in the throat.

There are no specific tests to diagnose dysphonia, the diagnosis is usually based on the patient’s description of the symptoms and the sound of the patient’s voice.

Most common causes of dysphonia are harmless and self-limiting and can therefore be managed without the need for medical intervention.

Most infectious forms of laryngitis are caused by viruses and therefore do not respond to or require antibiotic treatment, they will resolve on their own within 7-10 days.

However, where dysphonia persists for more than 3-4 weeks or is associated with any of the red flag symptoms listed above, further investigations may be warranted such as a chest x-ray, blood tests and/or specialist referral to exclude a more serious underlying cause. If in doubt you should discuss your symptoms with your GP.

If your GP is concerned, they may suggest referral to an Ear Nose & Throat surgeon (ENT). The surgeon will examine the throat to help identify the cause of your vocal symptoms. This is done by passing a flexible telescope through the nose (Fibreoptic Endoscope). This examination is done at the time of your out-patient visit and does not require hospital admission. Depending on the clinical findings, the following treatments may be recommended:

Simple advice:

As described above for intermittent mild hoarseness.

Voice therapy (Speech and Language Therapist):

Most patients will have no structural abnormality identified. The problem with their voice will be related to the way they are using their voice i.e., they are ‘straining’ it in some way. In this case a voice therapist will be able to give advice or suggest exercises that might help the quality of the voice. Voice therapy may require more than one visit to the therapist.

Microlaryngoscopy:

An operation to remove nodules, polyps and non-cancerous (benign) tumours may be recommended if these are identified at the outpatients visit. This type of operation is usually done under general anaesthetic using a rigid telescope (Endoscope) and a microscope (to provide magnification). It can remove the problem in the case of polyps, nodules or cysts and will provide a piece of tissue for laboratory analysis (a biopsy). If a malignant (cancerous) tumour of the larynx is diagnosed by biopsy then further treatment will be planned at a cancer team meeting and discussed with the patient.

If you have been referred for a specialist opinion your details will be reviewed, and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

How long will I wait?

If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.

• Waiting times
• Find services near you