All about Voice Change

What is voice change or hoarseness?

Vocal cords also known as vocal folds or vocal reeds are folds of throat tissues that are responsible for creating sounds. The condition of voice change or hoarseness or dysphonia arises from certain issues with the vocal cords. It is seldom considered as a serious ailment if it heals within a few days. But if the condition of hoarseness persists for more than two weeks, then one should immediately visit an ENT specialist to eliminate the chances of larynx cancer.

All about Voice Change 1

What are the causes of voice change or hoarseness?

The causes of voice change or hoarseness can be summed up as:
  • Using one’s voice too much can be termed as vocal abuse which can strain or harm the vocal cords.
  • Cold or sinus infection is basically the inflammation of the nasal chambers.
  • Laryngitis is the inflammation of one’s voice box from overuse, irritation or infection.
  • Gastroesophageal reflux (GERD) (stomach acid reflux) arises when stomach acid frequently flows back into the tube connecting one’s mouth and stomach.
  • Vocal fold hemorrhage is caused by blood which has leaked into one’s vocal fold from an injured blood vessel. 
  • Neurological diseases and disorders affect one’s voice muscles in the larynx causing it to twitch. 
  • Vocal nodules, cysts and polyps are benign or non-cancerous growths that are related to vocal trauma or overuse.
  • Vocal fold paralysis is a disorder where one can not manage the movement of the muscles that control his / her voice. 
  • Laryngeal cancer affects the voice box.
  • Recurrent respiratory papillomatosis (RRP / laryngeal papillomatosis) is a rare chronic disease where wart-like tumors grow around the vocal cords caused by human papillomavirus. 
  • Muscle tension dysphonia occurs when there is too much muscle tension in and around the voice box.
  • Tobacco smoking is the habit of burning tobacco and inhaling the resulting smoke.
  • Drinking caffeinated and alcoholic beverages which tends to induce health issues.
  • Screaming or prolonged singing can result in injury to the vocal cords or vocal folds.
  • Allergies arise when one’s immune system reacts to a foreign substance like pollen, bee venom or pet dander. This causes swelling of the vocal folds from cough, post-nasal drip and sneezing. 
  • Coughing excessively can be associated with other symptoms like dizziness or shortness of breath.
  • Voice box trauma emerges when the voice box or larynx gets injured.
  • Rheumatoid arthritis is an autoimmune disease that can affect more than just one’s joints.
  • Vocal cord atrophy is a condition where the vocal folds slowly alter as aging occurs.

What are the symptoms of voice change or hoarseness?

The symptoms of voice change or hoarseness can be listed as:
  • Breathy voice
  • Raspy voice
  • Strained voice
  • Voice gets differently pitched
  • Voice shows different volume levels than usual
  • Inconsistent voice
  • Shaky voice
  • Difficulty in breathing
  • Weak voice
The diagnosis of voice change or hoarseness by the ENT specialist consists of the following steps:
  • Taking a complete history of the hoarseness problem and overall health
  • Carrying out physical checkup of the voice box and its encompassing area (using tools like mirror, flexible laryngoscope, rigid laryngoscope or videostoboscope)
  • Assessing the quality of voice
  • Based on the conclusions of the physical check up, the ENT specialist may prescribe basic precautions or suggest for lab tests, X-rays, or thyroid function testing
The cure for voice change or hoarseness depends on the condition causing it:
  • Using one’s voice too much can be treated by resting the voice and drinking ample water.
  • Cold or sinus infection can be treated by using prescribed medications.
  • Laryngitis can be treated with prescribed antibiotics or corticosteroids.
  • Gastroesophageal reflux (GERD) can be treated using antacid and proton pump inhibitors.
  • Vocal fold hemorrhage can be treated by relaxing one’s voice.
  • Neurological diseases and disorders can be treated by a speech-language pathologist and an otolaryngologist.
  • Vocal nodules, cysts and polyps can be treated using dietary changes or voice therapy or surgery.
  • Vocal fold paralysis can be treated using a surgery performed by an ENT specialist.
  • Laryngeal cancer can be treated using radiation therapy, chemotherapy, immunotherapy and surgery.
  • Recurrent respiratory papillomatosis (RRP / laryngeal papillomatosis) can be treated by surgically removing the noncancerous growths. 
  • Muscle tension dysphonia can be treated through observation or voice therapy.
  • Avoid tobacco smoking to prevent voice change or hoarseness.
  • Restrain from drinking caffeinated and alcoholic beverages.
  • Screaming or prolonged singing can be treated by resting one’s voice.
  • Allergies can be treated using hydration by drinking loads of fluids.
  • Coughing excessively can be treated using medications prescribed by an ENT specialist.
  • Voice box trauma can be treated using voice therapy, medications or surgery.
  • Rheumatoid arthritis can be treated using therapy, medications or surgery.
  • Vocal cord atrophy can be treated using voice therapy or phonomicrosurgery. 
The factors related to voice change or hoarseness are:
  • Aging 
  • Alcohol use
  • Allergies
  • Conditions linked to the brain and nervous system (Parkinson’s disease or stroke)
  • Gastroesophageal reflux disease
  • Ailments such as colds or upper respiratory infections
  • Damage from neck surgery or from trauma to the front of the neck
  • Smoking
  • Throat cancer
  • Throat dehydration
  • Thyroid problems
  • Misuse or overuse of voice

What precautions should be taken for voice change or hoarseness?

All about Voice Change 3
The following precautions should be taken for voice change or hoarseness:
  • Give up on smoking
  • Avoid getting exposed to passive or second hand smoke
  • Drink ample of water and other hydrating fluids
  • Cut down on the consumption of caffeine and alcohol
  • Practice using a humidifier at home
  • Prevent from having spicy food
  • Avoid speaking too loud
  • Avoid speaking for long stretches at one go
  • Visit an ENT specialist if the condition of hoarseness continues

When to consult an ENT specialist?

Consult an ENT specialist if:

  • Hoarseness lasts longer than three weeks
  • One does not have a cold or flu
  • One is coughing up blood
  • One has difficulty in swallowing
  • One feel a lump in the neck
  • One observes loss or serious changes in voice lasting longer than a few days
  • One experiences pain when speaking or swallowing
  • Difficulty in breathing accompanies voice change
  • One is a vocal performer and has difficulty in performing

Medically reviewed by SinusDoctor,
Dr G V K Chaitanya Rao

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