Hoarseness / Dysphonia
Summary/Definition
Hoarseness or dysphonia is a symptom associated with voice changes due to various diseases that can occur in both the larynx and the speech tract. Patients presenting to a health care facility with voice problems often present with the following symptoms: hoarseness, inability to produce high-pitched sounds, onset of harsh or whistling sounds, and rapid fatigue of the vocal cords. These manifestations indicate that hoarseness of voice can be caused by a variety of conditions, rather than being limited to just one. Typical causes of hoarseness include inflammation, tumors, nerve or muscle abnormalities, and systemic diseases. Inflammation can be caused by a variety of factors, including physical or chemical exposure and viral or bacterial infections. One typical example of inflammation is laryngitis. Tumors can lead to gradual and chronic changes in the mucous membrane of the vocal cords, which in turn leads to voice changes. Voice disorders can also result from abnormalities in the structure of the vocal cord mucosa and in the functioning of the laryngeal muscles and nerves.
Diagnostics
The doctor assesses the patient’s symptoms through a thorough physical examination and checks the condition of the larynx using a laryngoscope. As part of the physical examination, the doctor determines when and under what circumstances the symptoms occur, how severe they are and how the voice changes. Provoking factors such as colds, allergic reactions, intense strain on the voice, etc. are also taken into account. Laryngeal endoscopy is an informative and minimally invasive diagnostic method that assesses the condition of the larynx and vocal cords using an endoscope. Laryngeal function tests can range from simple sound analysis through audition to more sophisticated methods using specialized acoustic assessment equipment. The most common methods are aerodynamic studies and vocal cord vibration tests.
Symptoms
Diseases of the mucous membrane of the larynx include vocal cord nodules and polyps. Vocal cord nodules form due to constant or excessive strain on the vocal cords. This condition is most common in boys aged 6-7 years, in women over 30 years of age, and in individuals whose occupations involve heavy vocal use, such as singers, teachers, and others. Symptoms of nodules often recur due to vocal cord overload or upper respiratory tract infections. Nodules are manifested by hoarseness in the voice when speaking normally or at high pitches, and raucity may also occur. Vocal cord polyps usually develop on one of the vocal cords and are the most common disease of the larynx in adults. The main causes of their formation are excessive strain on the vocal cords, smoking, as well as other factors including long-term use of anticoagulants, alcohol consumption, gastric acid reflux that irritates the larynx, hypothyroidism, and others.
Among infectious diseases, infectious laryngitis in adults is mostly caused by viruses and is considered part of the cold symptom complex. One of the main causes of such laryngitis is rhinovirus, often accompanied by dry air (low humidity), smoking and excessive strain on the vocal cords. Gastroesophageal reflux disease (GERD) is characterized by the main symptoms such as heartburn and esophagitis, whereas the symptoms of pharyngeal reflux disease are dysphonia, coughing, and foreign body sensation in the throat.
Smoking and alcohol consumption are major risk factors for laryngeal cancer, and changes in the voice may be an important indicator for diagnosis of the disease. However, if cancer develops in the upper or lower larynx, there may be no change in the voice in the early stages, and early symptoms may include non-specific throat discomfort and a foreign body sensation when swallowing. Unilateral vocal cord paralysis, which is one of the neurological disorders of the larynx, can usually result from medical procedures, cancer, or be idiopathic in nature. Cancer of the larynx, lungs or esophagus can affect the nerves and cause vocal cord paralysis. The disease can also be caused by neurological conditions such as stroke or systemic diseases such as gout. In idiopathic vocal cord paralysis, which has no clearly defined cause, recovery from temporary voice impairment can sometimes occur on its own.
Treatment and course of the disease
Patients with vocal cord nodules undergo conservative treatment, including moistening of the laryngeal mucosa, stabilization of the vocal cords, voice therapy and treatment of pharyngeal reflux disease. In the early stages, most vocal cord nodules can be treated with conservative methods alone. In case conservative treatment does not yield the expected results, surgical intervention is considered. In case of polyps on the vocal cords, the cause of the polyps is first eliminated using conservative treatment. If the polyps are small in size or detected in the early stages of development, short-term vocal therapy may take place.
Infectious laryngitis usually resolves on its own. Symptom relief can be achieved by stabilizing the vocal cords, ensuring adequate humidity, stopping smoking and drinking enough water. Anti-inflammatory drugs and antibiotics may be prescribed if necessary. For pharyngeal reflux, depending on symptoms, improvement may be achieved by correcting dietary habits and lifestyle, using antacids and other medications that reduce the acidity of gastric acid, and gastrointestinal stimulants or prokinetics. Laryngeal cancer is divided into early and late stages of the disease. Treatment for early stages of laryngeal cancer may include radiation or surgery depending on the condition of the voice (presence of hoarseness, raucity, etc.), swallowing function and other symptoms. Advanced stages of laryngeal cancer are treated with surgery and chemotherapy.
If one of the vocal cords is paralyzed, treatment is aimed at restoring normal voice and preventing aspiration. This may include monitoring, voice therapy and, if necessary, surgery.
