HOARSENESS: WHEN SHOULD I BE CONCERNED?

Find out reasons for hoarseness & when a croaky voice should be checked.

The ability to speak is an amazing co-ordination of breathing and movement of the voice box. With subtle changes to how the muscles of the larynx and throat are activated, we have the ability to generate this mechanism that we call speech. So, what could go wrong? Well lots of things actually.

Causes of hoarseness: 1. Infection & inflammation:

People who have a hoarse voice are often informed that they have laryngitis. This actually is just the medical word for an inflamed voice box. True laryngitis has a few causes, and these are mostly selflimiting as to how long the voice will be croaky for. For example, if you have a viral infection and it causes inflammation in your voice box, you should be better within a few days and there is no reason why it should recur.

2. Straining and overuse:

If you have been yelling and screaming at a sporting event or hitting the high notes at a concert or karaoke, you may cause some temporary damage within the voice box from straining it and this will cause some temporary swelling in the voice box that should be better within a day or so.

3. Reflux of food:

Another cause of hoarseness is reflux. This is where stomach acid comes back up into the throat. It may cause irritation and if it is persistent then the voice may be croaky for quite a while.

4. Smoking:

One other cause is smoking. But smoking can lead to more serious causes of a croaky voice so making assumptions is fraught with the risk of missing the nasties.

When is a croaky voice a problem?

If hoarseness has persisted for 2-6 weeks, and by then all temporary causes should have resolved. If the croaky voice persists then, it is time to see an ENT professional to have the voice box examined. In such cases this can usually be done in the office setting and sometimes will also require an assessment in hospital under a general anaesthetic.

This advice applies equally to adults and children:

In children: the most common cause of a chronic croaky voice is nodules, which are benign swellings on the vocal cords due to too much yelling and screaming and singing. These swellings

If a croaky voice persists, it is time to see an ENT professional to have the voice box examined

are a consequence of behaviour and sometimes require the input of a speech therapist to help them go away. Very rarely to they need to be removed surgically. However, reassuring this may sound, kids can get sinister things too. The most serious one is the development of warts within their larynx. These grow just like any other warts do but they can be very difficult to eradicate and warts can spread down into the lungs and even lead to lung cancer. So, whilst it is rather rare, it is obviously really serious.

In adults: the real worry is cancer, especially in those that smoke, drink excessive alcohol, or have poorly controlled reflux, as these three things are risk factors for throat cancer. There are many other causes, and this includes the warts as described in children (above), a paralysed vocal cord due to a brain or nerve problem, benign cysts, and natural wear and tear from the aging process. There are many more, but that is a good general list, and the most important one obviously is cancer. Like any cancer, if we catch it early, then we have the best chances of success. So, if your voice goes croaky and it persists for more than 2-6 weeks, it is time to see the ENT specialist!

Dr David McIntosh is a Paediatric ENT Specialist with a particular interest in airway obstruction, facial and dental development and its relationship to ENT airway problems and middle ear disease. He also specialises in sinus disease and provides opinions on the benefit of revision of previous sinus operations. Dr McIntosh can be contacted via this website.

To have what you have never had, you have to do what you have never done. - Roy T. Bennett