Hoarseness
Hoarseness is a condition marked by changes in the pitch or quality of the voice, resulting in a weak, soft, strained, scratchy, or husky voice. It results from conditions affecting the voice box. This common disorder can impact our ability to project our voices, maintain conversations, and express ourselves fully.
If left untreated, hoarseness can significantly negatively impact both personal and professional life. While a hoarse voice following upper respiratory tract infections or prolonged shouting is normal, persistence beyond two weeks warrants medical attention.
What is Hoarseness?
Hoarseness refers to an abnormal change in voice quality resulting from problems with the vocal cords or the larynx (voice box). It is not a condition itself but rather a symptom of an underlying problem affecting the vocal mechanism. The vocal cords within the larynx vibrate to produce sound when air passes through them. For a clear voice, the cords must close properly and vibrate symmetrically. Hoarseness occurs when these vibrations are disrupted by swelling, irritation, or structural abnormalities, altering the sound produced.
Characteristics of hoarseness include a breathy or strained voice, reduced volume, or difficulty maintaining a steady pitch. The severity and duration of hoarseness can vary, ranging from mild cases caused by vocal strain to chronic issues linked to conditions like acid reflux or throat cancer. Recognising the nature of hoarseness can help identify its root cause and determine the appropriate treatment.
If left untreated, hoarseness can significantly negatively impact both personal and professional life. While a hoarse voice following upper respiratory tract infections or prolonged shouting is normal, persistence beyond two weeks warrants medical attention.
What are the Symptoms of Voice Hoarseness?
Hoarseness manifests as changes in voice quality that can interfere with speaking or singing. Common symptoms include:
- Raspy or breathy voice: voice affected by hoarseness may sound coarse, weak, airy, and difficult to project
- Vocal fatigue: prolonged voice use can lead to vocal fatigue, characterised by tiredness or strain in the vocal cords.
- Pitch and volume changes: individuals may struggle to control their pitch or maintain a normal volume, especially during the extended duration of speaking or singing.
- Throat discomfort: a dry or scratchy sensation is a common symptom of vocal fatigue, often leading to frequent throat-clearing
- Reduced vocal range: singers may especially notice difficulty reaching higher or lower notes than usual.
These symptoms can be short-term and resolved with rest. However, prolonged hoarseness that lasts more than two weeks should not be ignored, as it may signal a more serious condition requiring care from an ENT specialist.
What are the Causes of Voice Hoarseness?
Acute Causes
Acute hoarseness often arises from temporary factors affecting the vocal cords.
- Laryngitis: One of the most common causes is laryngitis, an inflammation of the vocal cords caused by viral or bacterial infections. Laryngitis leads to swelling and prevents the vocal cords from vibrating properly. Thus, it results in a hoarse or raspy voice being projected.
- Excessive Usage of the Voice: Besides laryngitis, vocal strain due to overuse of the vocal cords can also cause temporary hoarseness. Overuse of the vocal cords includes shouting or speaking for a long time without rest. The vocal strain might lead to minor injuries on the vocal cords, resulting in irritation and voice fatigue.
- Environmental Irritants: Smoke, dust, or dry air can also trigger hoarseness by inflaming or dehydrating the vocal cords. Most of the time, these causes can be resolved with rest, adequate hydration, and avoiding irritants. However, repeated exposure or neglect can contribute to chronic issues that might require additional treatment.
Chronic Causes
In some cases, the cause of hoarseness could be chronic. Hoarseness could be the result of long-term or recurring conditions that impair the vocal cords.
- Laryngopharyngeal Reflux: One common cause is acid reflux (laryngopharyngeal reflux), where stomach acid irritates the throat and vocal cords. Over time, this can lead to chronic inflammation and voice changes.
- Excessive Smoking: The toxins in cigarette smoke cause irritation, swelling, and damage to the vocal cords. If exposure is prolonged, the risk of chronic laryngitis and throat cancer may increase.
- Structural Abnormalities in the Vocal Cord: Vocal cord lesions such as cysts, polyps, nodules, papilloma, or cancers, laryngitis, and vocal cord palsy. Untreated vocal cords may not vibrate and function properly, thus giving a strained or raspy quality to the projected voice.
- Throat Cancer: In rare cases, chronic hoarseness may be a symptom that signals serious conditions like throat cancer. Tumours in the larynx can affect vocal cord movement, leading to a progressive voice change.
Early detection is crucial, as untreated chronic conditions can result in irreversible vocal damage or more severe health issues.
How does a Throat Specialist in Singapore Diagnose Hoarseness?
At Aglow ENT Centre, diagnosing hoarseness begins with a consultation with our experienced ENT specialist, Dr Ker Liang. It typically includes the following components:
- Detailed Medical History Taking: The ENT specialist will first review the patient’s medical history, lifestyle habits, and symptoms while taking notes of other factors like smoking, acid reflux, or recent vocal strain. This process helps the ENT specialist to identify potential underlying causes.
- Physical Examination: Then, a physical examination of the throat and larynx is conducted to detect visible signs of inflammation, swelling or other abnormalities.
- Flexible Naso-Endoscopy: For a closer assessment, ENT specialists often use diagnostic tools such as flexible naso-endoscopy, where a thin yet flexible camera is inserted through the nose or mouth to examine the vocal cords. This procedure provides a clear view of the vocal cords and their surrounding structures. Furthermore, a clear view of the vocal cords enables ENT specialists to pinpoint the source of hoarseness.
- Video-Stroboscopy: Stroboscopy may be used in cases where structural abnormalities or tumours are suspected. This technique uses strobe light to evaluate the vibration and movement of the vocal cords in slow motion.
- Imaging Scans: Additional diagnostic tests, such as a Chest X-ray or Computer Topography Scan of your neck, chest, and brain, may also be conducted to determine a diagnosis.
Accurate diagnosis by an experienced ENT specialist is essential to developing an effective treatment plan and ensuring optimal vocal recovery.
What are the Treatment Options Available for Voice Hoarseness?
Non-Surgical Interventions
- Voice Rest: Recommending periods of reduced or no vocal activity to allow the vocal cords to heal.
- Proper Hydration: Encouraging increased fluid intake to keep vocal cords moist and reduce irritation.
- Medications:
- Proton Pump Inhibitors (PPIs) or antacids for hoarseness caused by acid reflux.
- Anti-inflammatory medications to reduce swelling of the vocal cords.
- Antibiotics in cases where bacterial infections are contributing to hoarseness.
- Allergy Management: Prescribing antihistamines or recommending lifestyle changes to address allergies that contribute to postnasal drip and irritation.
Surgical Interventions
For more severe cases, surgical intervention may be required:
- Phonosurgery/Microlaryngoscopy: Phonosurgery can accurately remove vocal cord lesions such as nodules, polyps, or cysts on the vocal cords to restore vocal quality while preserving surrounding tissue.
- Laser Surgery: Advanced treatment for structural abnormalities or tumours on the vocal cords with high precision.
- Medialisation Thyroplasty: A procedure to reposition or augment vocal cords in cases of paralysis or weakened vocal cord function.
- Injection Laryngoplasty: Injecting fillers or medications to improve vocal cord closure and voice quality in cases of vocal cord paresis.
Most patients can significantly improve their voice quality by combining lifestyle adjustments and medical treatments. Discussing your condition with our ENT specialist helps her develop an effective and tailored treatment plan.
When should you see a Throat Specialist in Singapore?
Consult an ENT specialist if you experience persistent hoarseness lasting more than two weeks, vocal fatigue, or difficulty projecting your voice. Other warning signs include throat pain, difficulty swallowing, or unexplained voice changes.
Ignoring these symptoms can lead to long-term complications, such as permanent vocal cord damage, chronic laryngitis, or even life-threatening conditions like throat cancer. Early diagnosis is crucial to prevent worsening symptoms and ensure timely intervention.
Treat Symptoms of Hoarseness and Schedule a Consultation with our ENT Specialist
If you are experiencing concerns regarding your voice quality, specifically hoarseness, book a consultation with an ENT specialist for an accurate diagnosis and personalised treatment plan. Early intervention can protect your vocal health and restore your confidence.
Clinical Practice and Expertise
Please consult an ENT specialist if you are suffering from any ear, nose, or throat symptoms. It is also advisable to visit an ENT doctor if you experience persistent mouth breathing due to a chronic blocked nose or encounter snoring issues.
Dr Ker Liang sees adults and children for general ENT conditions and provides comprehensive management in a broad range of Ear, Nose, and Throat, as well as Head and Neck conditions. In particular, she specialises in treating throat and voice conditions, including persistent sore throat, voice issues, snoring, and Obstructive Sleep Apnoea (OSA).
Medical Teaching
Assistant Professor Ker Liang has a passion for teaching and is an Assistant Professor with NUS Yong Loo Lin School of Medicine (YLLSOM). As the NUS-NUH Otolaryngology Department Undergraduate Medical Director, Dr Ker Liang supervises the training of medical students from YLLSOM, NUS. She is actively involved
in the training of postgraduate junior doctors and residents in the Head and Neck Surgery department. She was conferred with an Undergraduate Teaching Award by the National University Health System in 2016 for her outstanding efforts as an Otolaryngology educator.
Medical Teaching
Assistant Professor Ker Liang has a passion for teaching and is an Assistant Professor with NUS Yong Loo Lin School of Medicine (YLLSOM). As the NUS-NUH Otolaryngology Department Undergraduate Medical Director, Dr Ker Liang supervises the training of medical students from YLLSOM, NUS. She is actively involved
in the training of postgraduate junior doctors and residents in the Head and Neck Surgery department. She was conferred with an Undergraduate Teaching Award by the National University Health System in 2016 for her outstanding efforts as an Otolaryngology educator.
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