What is Dysphonia (Hoarse Throat)?
Dysphonia, a general term for changes in voice quality or production, is a common issue that affects about one-third of people worldwide at some point in their lives. Often referred to as hoarseness, it is a change in voice quality that can be noticed by individuals themselves. Although it can be a natural part of aging, dysphonia could also signal a serious underlying health issue. Thus, it’s important for healthcare professionals to consider further examinations if a patient’s dysphonia lasts more than four weeks or is linked with other worrying symptoms or risk factors.
If a person’s voice changes and doesn’t improve over four weeks, they should be referred for further evaluation, including a visual examination of the larynx (voice box). Any sudden changes in voice should be a red flag for healthcare professionals, implying that there could be a harmful underlying health problem. Regardless of how quickly these severe symptoms appear, they should be assessed as soon as possible.
Dysphonia can result from various conditions affecting the larynx or other structures beyond the larynx, and it can sometimes be tricky to evaluate. Early detection of symptoms by both the patient and their healthcare provider, as well as a thorough examination of the larynx, are key for an early diagnosis. However, the varied terms used for different laryngeal lesions and the difficulty in adequately examining the larynx may hinder an accurate diagnosis of dysphonia. Therefore, it’s often a challenge for healthcare providers to diagnose dysphonia, resulting in delayed diagnoses and treatment due to misdiagnosis or lack of awareness. Treating dysphonia requires in-depth knowledge and a team of professionals working together.
Dysphonia can impact individuals of any age or gender, but it’s more commonly found among teachers, older adults, and others who use their voice extensively. In fact, about 1 in 13 adults experiences voice problems every year.
What Causes Dysphonia (Hoarse Throat)?
Dysphonia, or voice problems, are usually caused by abnormal vibrations in the vocal cords. These could be due to several factors such as muscle irregularities, incomplete closing of the voice box while speaking, changes in the size of the vocal cords, or a lump or tumor on the vocal cords. Vocal cord nodules, which are quite common, are typically caused by improper or excessive use of the voice.
Smoking is a major risk factor for pre-cancerous and malignant voice box cancer. Squamous cell carcinoma is the most common type of cancer that affects the vocal cords, making up 85% to 95% of all vocal cord cancers. In this type of cancer, dysphonia initially results from defective vibrations caused by the lesion on the surface of the vocal cord which may get worse as the cancer spreads to the vocal ligament and voice box muscle. Also, the vocal cord can become stiff or immobile, which may be a sign of cricoarytenoid unit involvement.
Please note that dysphonia is a common symptom that can be linked to many diseases. Some people with head and neck tumors may have dysphonia. It’s critical to recognize such symptoms because delays in evaluation can lead to late diagnosis, higher disease stages, the need for intense treatment, and worse outcomes. Other conditions that may result in dysphonia include:
* Neurological conditions like vocal fold paralysis, spasmodic dysphonia, essential tremor, Parkinson’s disease, multiple sclerosis, and amyotrophic lateral sclerosis.
* Gastrointestinal conditions like reflux esophagitis, eosinophilic esophagitis.
* Autoimmune disorders like rheumatic arthritis, Sjögren’s syndrome, amyloidosis, sarcoidosis, and granulomatosis with polyangiitis.
* Allergies
* Pulmonary conditions like chronic pulmonary obstructive disease
* Musculoskeletal conditions like muscle tension dysphonia, fibromyalgia, and neck pain.
* Psychological factors.
Some traumatic causes include voice box fracture, injury caused by medical treatment, inhalation injury, and blunt or penetrating trauma. Infections like candidiasis and side effects from certain medications – inhaled steroids, anticholinergics, antihistamines, decongestants, and antihypertensives – can also lead to dysphonia.
The chance of dysphonia occurring with these conditions differs. For example, patients with spasmodic dysphonia or other voice box disorders almost always have dysphonia. But not everyone with gastroesophageal reflux, a condition where stomach acid flows back into the esophagus, experiences voice difficulties.
Risk Factors and Frequency for Dysphonia (Hoarse Throat)
Dysphonia, a condition that affects the voice, is relatively widespread, with almost 30% of people experiencing it in their lifetime. It can happen to anyone, regardless of their age or gender. However, people who use their voices extensively, such as singers, teachers, and phone operators, are more likely to develop it. Another voice-related condition is vocal cord cancer, which, while rare, affects about 7 out of every 100,000 people.
According to a 2001 study in the United States, the number of people experiencing dysphonia at a given time was found to be about 0.98% of people seeking treatment. This condition is more common in women (1.2%) and people over the age of 70 (2.5%), compared to 0.7% in men and 0.6% to 1.8% in other age groups. However, these statistics may not fully represent dysphonia’s prevalence since many people with mild or temporary voice changes (like those caused by a respiratory infection) may not seek medical help.
Signs and Symptoms of Dysphonia (Hoarse Throat)
If you have a problem with your voice, known as dysphonia, a doctor will need to know certain things in order to diagnose and treat you effectively. This includes details such as how your voice sounds, if your voice tires out easily, if you have trouble controlling your voice’s pitch, how loud you can be, if it’s hard for you to produce your voice, if you run out of breath or feel breathless when speaking, and if your singing voice is affected. Also important is any history you have of voice problems, if you’ve had any related treatments or surgeries, your general medical history, any medications you’re on, environmental factors that could affect your voice, and your general voice habits.
There are some additional symptoms that could be associated with dysphonia that might suggest a more serious problem, like laryngeal cancer. These include losing weight, experiencing difficulty swallowing, coughing, spitting up blood, and getting frequent heartburn. Other warning signs could be issues with swallowing, shaking or abnormal movement in your tongue, hand or other body parts, difficulty walking, and slowed brain function if you have a neurological condition.
The most noticeable sign might be a hoarse voice. The doctor may assess this through casual conversation or more formal tests and will check for certain vocal characteristics such as overall quality, pitch, nasal sound, loudness, rhythm, and clarity of speech. They will also note if your voice is absent, shaky, has an abnormal low, bubbly sound, changes between two different pitches at once, or if it sounds ‘wet’ or gurgly.
The doctor might use the auditory-perceptual evaluation method, with the two most common systems being the GRBAS and CAPE-V scales, with GRBAS being the gold standard. This measures things like the degree of voice dysfunction, irregular sound, airy voice, weak voice, and voice that requires excessive effort. The severity of each feature is rated on a scale of 0 to 3, with 0 being normal and 3 being severe.
Apart from assessing your voice, the doctor will also examine your head and neck, and analyze your breathing patterns, particularly if you tend to hold your breath or use the residual air while speaking.
Testing for Dysphonia (Hoarse Throat)
To understand and keep track of a patient’s voice condition, doctors often use questionnaires. One of them, called the Voice Handicap Index, or VHI-10, offers insights into how the voice issue affects the patient daily, both functionally and emotionally. Other questionnaires like the standard VHI, Voice-Related Quality of Life (VRQoL), and Glottal Function Index (GFI) can also come into play.
If a patient continues having trouble speaking, a specialist known as an otolaryngologist will do an in-office examination of their voice box called a laryngoscopy. This procedure helps examine the structure and working of the voice box, using either mirrors or laryngoscopes – flexible or rigid types. The examination, during which the patient is asked to vocalize, can be recorded for review. Such direct view of the voice box can sometimes reveal abnormal changes not visible in CT scans or MRIs. As such, imaging is not routinely recommended before an endoscopic review.
A laryngoscopy proves incredibly important in examining the openness of the voice box in patients suffering from voice box trauma. In these cases, viewing the voice box can help doctors decide if a surgical airway should be considered or if regular folloup is suitable. This procedure is beneficial to diagnose fungal voice box inflammation, often caused by inhalers and needs distinguishing from cancers. In addition, it is also employed for identifying a neurologic cause behind a voice dysfunction, be it due to neuromuscular alterations or cranial nerve deficits.
Common voice box issues like cysts, nodules, and polyps on the vocal folds can be noticed in a laryngoscopy. However, a form of visual examination known as stroboscopy can identify these conditions more easily. In this procedure, a pulsed light is synced with the patient’s voice frequency to create a slow-motion view of the vocal folds’ movement. This is considered the best tool to check on abnormal voice conditions because it provides insights on properties like regularity of voice box movements, waveform of the mucous membrane covering the voice box, symmetry of the vocal folds and their closure pattern. It can also detect issues missed in standard flexible or rigid endoscopy exams. Additionally, stroboscopy can play a part in monitoring conditions in patients with malignant tumors.
Treatment Options for Dysphonia (Hoarse Throat)
If you’re diagnosed with dysphonia, which is a problem with the voice, there are several treatment options available. These might include speech therapy, medication, surgery, or possibly a mix of these approaches. However, doctors strongly advise against treating dysphonia with certain medications, like proton-pump inhibitors, antibiotics, and steroids, before being checked by an ear, nose, and throat specialist.
In cases where the cause of dysphonia isn’t clear, steroids and antibiotics are usually avoided. For most patients who do not have signs indicating the need for surgical intervention (like a suspicion of cancer and issues with vocal cord movement), speech and language therapy is the first choice. This type of treatment is often effective, even for patients with non-dangerous growths on their vocal folds.
Surgery may be considered for individuals with benign, or non-cancerous, vocal folds lesions that don’t improve with speech therapy. There are other treatments for specific conditions; for example, people with laryngeal dystonias, a type of muscle disorder affecting the larynx, might benefit from botulinum toxin injections. If you have vocal fold granulomas, which are small areas of inflammation, steroid injections might work, and can be done in a doctor’s office or in an operating room. Similarly, people with vocal fold immobility can receive injections of collagen-based products or calcium hydroxyapatite in the office. These measures are temporary, but for permanent improvements, surgery can be an option.
This surgical procedure not only helps with dysphonia but also reduces the risk of aspiration, which could lead to pneumonia. It can be particularly beneficial for post-stroke patients, who might not be able to recover from an injury, or those who have incurred nerve damage following certain surgeries or because of invasive lung tumors.
If you’re diagnosed with laryngeal, or voice box, cancer, you might need chemotherapy, radiation, or surgery, depending on the severity of your condition. You may also need a combination of these treatments.
What else can Dysphonia (Hoarse Throat) be?
If someone is experiencing dysphonia, which is a difficulty in speaking or a change in voice, their doctor will consider a variety of possible causes, including:
- Acute laryngitis, a temporary inflammation of the voice box
- Chronic laryngitis, a long-lasting inflammation of the voice box
- Functional dysphonia and muscle tension dysphonia, voice disorders that involve the improper use of vocal muscles
- Benign vocal fold nodules and cysts, harmless growths on the vocal cords
- Malignant tumors such as squamous cell carcinoma or lymphoma
- Neurological conditions that affect the nervous system such as multiple sclerosis, vocal tremor, laryngeal dystonia (spasmodic dysphonia), Parkinson’s disease, amyotrophic lateral sclerosis, or myasthenia gravis
- Systemic conditions that affect the whole body like hypothyroidism, rheumatoid arthritis, systemic lupus, Wegener granulomatosis, sarcoidosis, or amyloidosis
- Tuberculosis, a bacterial infection that primarily affects the lungs, or aging
In order to identify the condition, the doctor may need to conduct various tests and thoroughly review the person’s medical history.
What to expect with Dysphonia (Hoarse Throat)
The future health outlook for people suffering from dysphonia (a speech disorder affecting the voice) greatly depends on the root cause of the condition. The outcome can be anywhere from poor to excellent. For instance, those with acute laryngitis, which typically just needs basic treatment to manage symptoms, generally recover in 1 to 3 weeks. However, people with conditions like muscle tension dysphonia, vocal fold nodules or polyps, or other types of functional dysphonia might need voice rest or several speech therapy sessions to see improvement.
When it comes to laryngeal cancer (cancer of the voice box), the stage of the cancer at the time of diagnosis greatly impacts the outlook. People with early-stage laryngeal cancer have reported 5-year survival rates of up to 95%. However, for those diagnosed with late-stage laryngeal cancer, the 5-year survival rates range from 30% to 63%, with the primary cause of death being the cancer spreading to other parts of the body. This stark contrast in survival rates between early and late-stage laryngeal cancer highlights the importance of early detection.
Possible Complications When Diagnosed with Dysphonia (Hoarse Throat)
Dysphonia, a condition that affects the quality of your voice, can impact many aspects of your life, both psychologically and physically. There are several causes of dysphonia, and treating these can sometimes result in complications. These complications may occur if a material is injected into the vocal fold and the vocal folds can’t be properly seen. They could include excessive saliva, bleeding near the vocal cords, blood clots after surgery, and swelling. While severe complications like difficulty breathing and accidental swallowing into the airways are rare, occurring in less than 5% of cases.
Laryngeal surgery, a surgical procedure to treat voice disorders, also has potential complications. These may include blood clots after surgery, swelling, infection, the need for a tracheostomy (a surgical hole in the windpipe) due to breathing problems, movement or extrusion of the implant, insufficient medialization (movement of the vocal cords to the middle), and the necessity for additional surgery.
Common Complications:
- Excessive saliva
- Bleeding near the vocal cords
- Blood clots after surgery
- Swelling
- Difficulty breathing
- Accidental swallowing into the airways
- Infection
- Need for a tracheostomy due to breathing problems
- Movement or extrusion of the implant
- Insufficient medialization
- Need for additional surgery
Preventing Dysphonia (Hoarse Throat)
If someone has been having a hoarse voice for a long time and also experiencing worsening shortness of breath, difficulties swallowing, and weight loss, it could be a sign of throat cancer. If you have these symptoms, it’s crucial to speak with a doctor who may refer you to an ear, nose, and throat specialist to rule out cancer.
If your voice has been hoarse for more than four weeks or is getting worse, it’s important that you see a doctor. Resting your voice and getting speech therapy is often the first step in treating non-cancerous throat conditions and voice strain.