Causes and Remedies of Hoarseness of voice (Dysphonia)

There are three essential components for voice production: an air source (the lungs); a vibratory source (the vocal cords); and a resonating chamber (the pharynx, the nasal and oral cavities). Although chest and nasal disorders can affect the voice, the majority of hoarseness is due to laryngeal pathology.

Inflammation which increases the 'mass' of the vocal cords will cause the vocal cord frequency to fall, giving a much deeper voice. Thus listening to a patient's voice can often give a diagnosis before the vocal cords are examined.


Vocal Nodules

Nodules (always bilateral and commoner in females) and polyps are found on the free edge of the vocal cord preventing full closure and giving a 'breathy, harsh' voice. They are commonly found in professions that rely on their voice for their livelihood, such as teachers, singers and lawyers. They are usually related to poor technique of voice production and can usually be cured with speech therapy. If surgery is needed, great care must be taken to remain in the superficial layers of the vocal cord in order to prevent deep scarring which may leave the voice permanently hoarse.


Reinke's oedema

This is due to a collection of tissue fluid in the sub epithelial layer of the vocal cord. The vocal cord has poor lymphatic drainage, predisposing it to edema. Reinke's edema is associated with irritation of the vocal cords as in smoking, voice abuse, acid reflux and vary rarely hypothyroidism.

Treatment is to remove the irritation in most cases but surgery to thin the cords will also allow the voice to return to its normal pitch.

Acute-onset hoarseness

This, in a smoker is a danger sign. Any patient with a hoarse voice for over 6 weeks should be seen by an ENT surgeon. The voice may be deep, harsh and breathy indicating a mass on the vocal cord or can be weak suggesting a paralyzed left vocal cord secondary to mediastinal disease, e.g. bronchial carcinoma.

Early squamous cell carcinoma of the larynx has a good prognosis. Treatment is with carbon dioxide resection or radiotherapy. Spread of the tumor can lead to referred otalgia (Ear pain) which may then require a laryngectomy with possible neck dissection. A patient with a paralyzed left vocal cord must have a chest X-ray. Medialization of the paralysed cord to allow contact with the opposite cord can return the voice and give a competent larynx. This can be done under local anesthesia, giving an immediate result whatever the long-term prognosis of the chest pathology.