Hoarseness of Voice
Sound is generated through the vibration of two flexible tissue bands known as the vocal cords. These folds move as air is breathed in and out through the narrow space between them, allowing sound to be produced.
Hoarseness is defined as an abnormal change in voice, arising from a variety of diseases and health conditions. This alteration can affect the pitch or volume of the voice, resulting in sounds ranging from deep and strained to weak and rough. It’s important to note that hoarseness is a symptom rather than a standalone condition.
Causes of Hoarseness
Hoarseness can occur for various reasons, most commonly resulting from issues with the vocal folds themselves. It may also stem from problems within the larynx or the nerves that control the vocal cords. Some potential causes of hoarseness include:
- Laryngitis: This is the most common cause of hoarseness, often resulting from colds, excessive shouting, or singing loudly at concerts.
- Vocal Cord Cysts or Polyps: These are growths that form on the vocal cords, impacting their normal function during speech. They typically arise from vocal strain, with singers, teachers, and others who rely heavily on their voices being more susceptible.
- Allergies: Seasonal or persistent allergies can lead to hoarseness. Allergic reactions may cause swelling of the vocal cords, and post-nasal drip can irritate them. Additionally, coughing due to allergies can strain the vocal cords, while antihistamines used to treat allergies may dry out the throat, further affecting vocal quality.
- Rheumatoid Arthritis: This autoimmune disorder causes pain, swelling, and stiffness in the joints. Notably, one in three individuals with rheumatoid arthritis may experience voice problems, including sore throat and loss of voice, due to the disease’s impact on delicate joints in the face and throat, which can affect breathing and vocal fold function.
- Acid Reflux: Gastroesophageal reflux disease (GERD) can irritate the vocal cords, larynx, and esophagus, leading to a hoarse voice and excessive throat mucus.
- Thyroid Disorders: Conditions like hypothyroidism can lead to hoarseness. An enlarged thyroid may cause frequent coughing and difficulty speaking, while abnormal tissue growths or nodules on the thyroid can also contribute to vocal changes.
- Smoking: Exposure to secondhand smoke can lead to a rougher voice.
- Exposure to Other Irritants: Air pollutants and household chemicals can also result in hoarseness.
- Inhaled Corticosteroids: Long-term use of inhaled corticosteroids for asthma or chronic obstructive pulmonary disease (COPD) may lead to changes in voice quality.
- Vocal Nodules: These growths resembling calluses can develop on the mid-portion of the vocal cords and may disappear with vocal rest.
- Cysts: Solid lumps of tissue can grow on or just beneath the surface of the vocal cords.
- Nervous System Disorders: Certain neurological diseases can affect the muscles responsible for voice production. For example, nearly 90% of individuals with Parkinson’s disease experience some form of speech or voice disorder. Other neurological conditions that can impact voice include stroke and multiple sclerosis.
- Laryngeal Cancer: Persistent hoarseness or voice loss can be a sign of laryngeal cancer. Additional symptoms may include pain while swallowing, ear pain, breathing difficulties, and neck lumps.
- Trauma: Sudden trauma to the throat area, such as an injury to the vocal cords from a car accident or damage from placing a tube down the throat during surgery or bronchoscopy, can lead to hoarseness.
- Spasmodic Dysphonia: This condition can cause muscle problems in the larynx, resulting in voice changes.
- Recurrent Laryngeal Nerve Paralysis: Damage to the nerves leading to the larynx during surgeries, such as thyroid surgery or heart surgery, may result in hoarseness.
- Leukoplakia: Also known as white plaque, this condition leads to thick white patches on the tongue, gums, and inner cheeks, which may appear transparent or gray.
Less Common Causes of Hoarseness
Other potential causes of hoarseness include:
- Croup: A viral infection causing swelling around the vocal cords, it primarily affects children under five years old, especially during the fall and winter months.
- Epiglottitis:
- Esophageal Cancer:
- Myasthenia Gravis: A rare muscle disorder leading to weakness in muscles used for movement.
- Growth Hormone Excess: This rare condition results from increased production of growth hormone in the body.
- Peritonsillar Abscess: This is a complication of tonsillitis or other bacterial infections.
- Sjögren’s Syndrome: An autoimmune disorder primarily affecting the salivary and tear glands.
- Lung Cancer:
- Cocaine Use:
- Necrotizing Vasculitis: This condition involves inflammation of blood vessel walls, which may obstruct blood flow and damage skin, muscles, and blood vessels.
- Amyotrophic Lateral Sclerosis (ALS): A degenerative disease affecting the brain and spinal cord, leading to loss of voluntary muscle control.
- Adrenal Gland Cancer: A rare disease affecting the outer layer of the adrenal glands.