Hoarseness or a hoarse voice is an impairment in which the voice sounds mostly different than normal and the spoken volume is limited. In rare cases, there may even be voicelessness or the affected person may only be able to whisper.
What is hoarseness?
In the context of colds or overuse of the voice, hoarseness passes quickly, permanent hoarseness, however, requires a presentation to an otolaryngologist for clarification. In the diagnosis of hoarseness, medicine distinguishes disphonia – a change in the voice caused by strain on the vocal cords or laryngeal disease – from aphonia, which describes the lack of voice in the context of the disease. Dysphonia is characterized by a change in the pitch and strength of the patient’s voice. The voice is conspicuous for its soft, croaky and especially deep tones when speaking. In the context of colds or overuse of the voice, hoarseness passes quickly, permanent hoarseness, however, requires a presentation to an otolaryngologist to clarify whether a serious disease (laryngeal cancer) is the trigger of hoarseness.
Causes
Most of the time, hoarseness is harmless. It usually disappears as quickly as it came. Most often, hoarseness occurs in the course of a cold and is often accompanied by a sore throat. Anatomically, the voice originates in the larynx. The vocal cords in it come together when speaking and close the throat almost completely. Sounds are produced when exhaled air escapes through this crack and the vocal cords are set in vibration. In hoarseness, this process is unnaturally impaired, so that the vocal cords can no longer vibrate freely. Causes are mostly infectious diseases such as colds, bronchitis and flu. However, hoarseness also often affects people who have to talk a lot and loudly, such as teachers. Here, the larynx in particular is affected by inflammation. Ultimately, external factors are also responsible for hoarseness. These include, above all, smoking, cold or too dry or warm room air, singing and shouting, which can massively attack the mucous membranes. In more serious cases, hoarseness can also occur in the context of benign tumors, such as vocal cord nodules or vocal cord polyps. Cancers, such as laryngeal cancer or labial ligament carcinoma can also not be ruled out.
Diseases with this symptom
- Common cold
- Vocal cord paralysis
- Pseudocroup
- Epiglottitis
- Struma
- Flu
- Laryngitis
- Vocal fold polyp
- Diphtheria
- Reflux disease
- Vocal cord inflammation
- Pharyngitis
- Vocal fold nodule
- Bronchitis
- Throat cancer
Complications
Hoarseness often occurs as a harmless symptom of various diseases, the cause of which can be found in flu-like infections, due to the overload of the vocal folds or other physical disharmonies. However, hoarseness that persists over a longer period of time can also indicate a serious illness or become a complication itself. Thyroid sufferers not infrequently complain of a “lump in the throat”. The feeling of pressure and tightness causes difficulty swallowing, irritation of the vocal cords and the associated hoarseness alternate in increasingly shorter periods. If the size of the thyroid gland increases enormously, the trachea is constricted. There is a threat of shortness of breath! Hoarseness with coughing irritation are signs of an acute inflammation of the larynx (laryngitis), as a result of which the mucous membrane of the larynx can swell. Bacterial inflammation of the epiglottis and subglottic laryngitis (pseudocroup), which usually occurs in children after a cold, are a major danger. The barking cough, difficult breathing with a hoarse voice occur in attacks and mainly at night. The child suffers from severe shortness of breath and is frightened. Until the emergency physician arrives, it is important to have a calming effect on the child, to hold him in your arms. Breathing in cold moist air with the window open has a decongestant effect. Complications or anesthetic incidents are also possible under medical treatment, such as during operations under anesthesia.By means of intubation, in which the physician inserts a tube through the mouth or nose, injuries to the pharynx, larynx, trachea or vocal cords can occur, which can leave permanent voice disorders due to hoarseness. However, this is extremely rare today due to the constant care of anesthesiologists and monitoring with the help of technical equipment.
When should you go to the doctor?
If hoarseness lasts longer than ten to 14 days, the cause should be clarified by a doctor. However, if other symptoms such as severe difficulty swallowing, pain or shortness of breath occur, a medical professional should be consulted immediately. The same applies if hoarseness is accompanied by high fever or a swollen throat: in these cases, it is often a bacterial infection that requires immediate treatment. Also, if the eyelids, lips or the entire face swell up in a seizure-like manner, a visit to the doctor should not be delayed under any circumstances. If hoarseness lasts only a few days, but returns again and again, it is also advisable to consult a doctor in order to rule out serious illnesses. The family doctor can be the first point of contact – but it is also possible to consult an ear, nose and throat specialist directly. Both the family doctor and the ENT specialist will refer the patient to a specialist, such as a phoniatrics specialist, an allergist or a neurologist, if necessary and depending on the suspected diagnosis.
Treatment and therapy
As a rule, hoarseness does not need to be treated, because it goes away on its own after a few days. Nevertheless, the voice should be spared. Speaking quietly is the top priority here. Furthermore, smoking is strictly prohibited. Drinking plenty of hot tea or milk with honey has a healing effect. Warm steam baths with chamomile extracts also promote the recovery process. However, if hoarseness persists or is combined with pain or shortness of breath, a doctor should be consulted immediately to clarify the causes of hoarseness. This involves checking how long the hoarseness has lasted, whether there is any pain or difficulty in swallowing, and whether there has been any contact with environmental irritants (such as smoke and chemical substances). This is followed by an examination of the body, during which the lymph nodes are palpated and the inside of the mouth and throat are examined. Often, blood is also drawn and a laryngoscopy is performed. Depending on the cause, further diagnoses are performed, such as an examination of the larynx via X-ray, ultrasound examination, tissue sampling from possible tumors or a computer tomography. If the hoarseness is related to another disease, this should be treated first. In case of bacterial inflammation of the larynx, antibiotics should be prescribed by the doctor. If vocal cord nodules occur, they should be removed endoscopically. Surgical interventions happen only in the case of laryngeal cancer, which is sometimes coupled with radiotherapy.
Outlook and prognosis
Everyone will experience hoarseness several times in life. If hoarseness is mild, it can be expected to disappear quickly. Especially if it is due to a known cause, such as not drinking enough fluids when speaking for a long time, it can often be resolved immediately. Fluid, a throat lozenge or herbal tea can provide relief. However, mild hoarseness is often a sign of an approaching cold. This lasts a few days and usually improves quickly. The exception can be a severe infection – or even the flu or tonsillitis. In these cases, hoarseness lasts longer than just a few days. Hoarseness is particularly unpleasant as a result of recurrent tonsillitis, which occurs mainly in childhood and more rarely still in adults. If the tonsils become inflamed frequently, they are removed to avoid the constant infections. Apart from infectious causes, hoarseness can also be due to throat irritation. It occurs, for example, after intubation anesthesia or surgery in the throat area. Provided there is no injury to the throat, hoarseness usually disappears within a few days. After surgical procedures, it can last a little longer and improves as soon as the mucous membrane of the throat heals. Fortunately, this happens more quickly than with normal skin, so hoarseness usually lasts only days even in these cases.
Prevention
Avoid loud and prolonged talking or even shouting. Drink regularly.Humidifiers can help against too dry and hot air. Avoid smoking and exposure to chemical irritants.
Home remedies and herbs for hoarseness
What you can do yourself
For hoarseness, a number of home remedies provide relief. Who is hoarse, should first spare his voice and speak as little and quietly as possible. To spare the vocal cords, hot, greasy or spicy foods and drinks should also be avoided. Constant throat-clearing should be avoided if possible, as this irritates the mucous membranes and can thus aggravate the symptoms. It makes more sense to gargle regularly, either with a saline solution or with sage or chamomile tea. Inhaling with salt water vapor or a solution is similarly effective. In addition, pastilles with sage or Iceland moss can help relieve hoarseness. Effective home remedies are also licorice root, thyme, fennel and mallow, these can be taken either as a tea or gargled and promise acute relief of symptoms. Often recommended remedies such as warm milk, on the other hand, should be avoided due to the risk of vocal cord slime. Harmful influences such as smoking or drinking, as well as stress and tension, should also be avoided during the illness. In addition, hoarseness should also always be discussed with the family doctor to ensure a speedy recovery.
