There are a number of medical conditions as well as voice use patterns that can lead to voice problems. The most common causes of hoarseness and voice problems are as discussed below.
If you become hoarse frequently or notice voice change for more than two weeks, please see your otolaryngologist (ear, nose, and throat doctor) for an evaluation.
1. Acute Laryngitis
Acute laryngitis is the most common cause of hoarseness and sudden voice loss. Acute laryngitis is usually caused by a viral infection that leads to swelling of the vocal folds.
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Swelling on the vocal folds changes the way they vibrate, and we hear this change as hoarseness. The best treatment for acute laryngitis is to stay well-hydrated and to rest your voice or limit your voice use. If you make heavy use of your voice when you have acute laryngitis, you are risking serious injury to the vocal folds.
Since most cases of acute laryngitis are caused by a virus, antibiotics are not effective.
Bacterial infections of the larynx are much rarer and are often associated with difficulty breathing. Of course, any breathing problems during an illness require emergency medical attention.
2. Chronic Laryngitis
Chronic laryngitis is a general term for inflammation of the vocal folds. Chronic laryngitis can be caused by acid reflux disease, exposure to irritating substances such as smoke, chronic misuse of the voice, and low-grade infection, such as a yeast infection of the vocal folds.
People using inhalers for asthma, as well as chemotherapy patients or others with suppressed immune systems, are susceptible to these infections.
3. Laryngopharyngeal Reflux Disease (LPRD)
Reflux of stomach acids into the throat can cause a variety of symptoms in the esophagus (swallowing tube) as well as in the throat. Common throat symptoms include hoarseness, swallowing problems, a feeling of having a lump in the throat, or throat pain.
LPRD can occur without any symptoms of heartburn and regurgitation that are traditionally associated with gastroesophageal reflux disease (GERD).
4. Voice Overuse and Misuse
Voice overuse and misuse put you at risk for vocal fold lesions and vocal hemorrhage.
5. Benign Lesions of the Vocal folds
Benign non-cancerous growths on the vocal folds are most often caused by inefficient voice use, which causes trauma to the vocal folds. These lesions (or “bumps”) on the vocal folds alter vocal fold vibration and lead to hoarseness. The most common vocal fold lesions are nodules, polyps, and cysts.
Vocal nodules (also known as nodes or singer’s nodes) are akin to “calluses” of the vocal folds. They occur on both vocal cords opposite each other at the point of maximal contact. Vocal nodules almost always improve with voice therapy.
Vocal fold polyps and cysts are also usually related to voice misuse or overuse but can sometimes occur in people who do use their voice properly. A patient with a cyst or polyp may find that the voice improves with voice therapy and optimal vocal hygiene, since swelling around the lesions may be reduced.
However, microsurgery is frequently needed to maximize vocal quality. Of course, a decision to undergo surgery is always based on discussions between the otolaryngologist and the patient, and will depend on the patient’s goals. Voice therapy is generally recommended before and after surgery.
6. Vocal Fold Hemorrhage
If you experience sudden loss of voice following yelling, shouting, or other strenuous vocal tasks, you may have developed a vocal fold hemorrhage, which can happen when a blood vessel on the surface of the vocal fold ruptures and bleeds into the tissue of the vocal fold.
It is considered a vocal emergency and is treated with absolute voice rest (silence) until the hemorrhage resolves. If you lose your voice after strenuous voice use, see your otolaryngologist as soon as possible.
7. Vocal Fold Paralysis or Paresis
The most common neurological condition that affects the larynx is paralysis or weakness of one or both of the vocal folds, resulting from problems between the nerves and muscles in the larynx (voice box). It is rare for both vocal folds to be affected, and in this case the primary concern is difficulty breathing.
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More commonly, when one vocal fold is paralyzed or weak, the voice is usually the problem rather than breathing. One vocal fold can become paralyzed or weakened (paresis) from a viral infection of the throat, after surgery in the neck or chest, from a tumor or growth along the laryngeal nerves, or for unknown reasons.
Vocal fold paralysis typically presents with a soft and breathy voice. Many cases of vocal cord paralysis will resolve within several months. In some cases, however, the paralysis will be permanent and may require intervention to improve the voice.
Treatment depends on the nature of the vocal fold paralysis, degree of vocal impairment, and the patient’s vocal needs, and may involve voice therapy and/or surgery.
While surgery cannot restore movement to paralyzed vocal folds, there are good surgical options for improving the voice. In cases of unilateral vocal fold paralysis, surgery can reposition or “bulk up” the vocal fold to improve contact between the two vocal folds and improve their vibration. There is a variety of surgical techniques used to accomplish this approach.
8. Laryngeal Cancer
Throat cancer is a very serious condition requiring immediate medical attention. Chronic hoarseness warrants evaluation by an otolaryngologist to rule out laryngeal cancer. It is important to remember that prompt attention to changes in the voice facilitates early diagnosis.
Remember to listen to your voice, because it might be telling you something. Laryngeal cancer is highly curable if diagnosed in the early stages.