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Swallowing Disorders: Dysphonia

January 25, 2021

Do you, or somebody you know, have a hoarse voice?

Do you feel your voice is weak, breathy, or raspy?

If so, you may be suffering from dysphonia.


What is Hoarseness?


Hoarseness, also known as dysphonia, is a term that describes an abnormal voice. Hoarseness may be described as breathy, raspy, a change in pitch, a change in loudness, straining of the voice, and an increased effort. These changes are usually due to disorders that affect the vocal cords, located in the voice box in the throat. Normally the vocal cords come together and vibrate to produce sound. Any swelling of the vocal cord, mass of the vocal cord, or difficulty moving the vocal cord can result in a change of voice.


What are the Causes of Hoarseness?


There are many causes of hoarseness. Fortunately, most are not serious and tend to resolve in a short period of time. The most common causes are acute laryngitis which usually occurs due to the swelling from a common cold, upper respiratory tract viral infection, or irritation caused by excessive voice use such as screaming at a sporting event or rock concert.


More prolonged hoarseness is usually due to using your voice either too much, too loudly, or improperly over extended periods of time. These habits can lead to vocal nodules (singer nodes), which are callous-like growths, or may lead to polyps of the vocal folds (more extensive swelling). Vocal nodules are common in children and adults who raise their voice in work or play. Uncommonly, polyps or nodules may lead to cancer, especially in smokers.



A common cause of hoarseness in older adults is gastroesophageal reflux and laryngopharyngeal reflux, when stomach acid comes up the swallowing tube (esophagus) and irritates the vocal folds. Many patients with reflux-related changes of voice do not have symptoms of heartburn. Usually, the voice is worse in the morning and usually improves during the day. These people may have a sensation of a lump in their throat, mucus sticking in their throat, or an excessive desire to clear their throat.


Smoking is another cause of hoarseness. Since smoking is the major cause of throat cancer, if smokers are hoarse, they should see an otolaryngologist.



Cancer may affect the vocal cords, often presenting with a change of voice and hoarseness. Although the majority of hoarseness is not cancer, persistent problems should be evaluated.


Many unusual causes for hoarseness include allergies, thyroid problems, neurological disorders, trauma to the voice box and occasionally the normal menstrual cycle. Many people experience some hoarseness with advanced age.


Who Can Treat My Hoarseness?


Hoarseness due to a cold or flu may be evaluated by family physicians, pediatricians, and internists (who have learned how to examine the larynx). When hoarseness lasts longer than two weeks or has no obvious cause it should be evaluated by a Laryngologist. A Laryngologist is an otolaryngologist–head and neck surgeon (ear, nose and throat doctor) who specializes in voice and swallowing problems. Problems with the voice are best managed by a team of professionals who know and understand how the voice functions. These professionals are Laryngologists, speech/language pathologists, and teachers of singing, acting, or public speaking. Voice disorders have many different characteristics that may give professionals a clue to the cause.


How is Hoarseness Evaluated?


An otolaryngologist will obtain a thorough history of the hoarseness and your general health. Your doctor will usually look at the vocal cords with either a mirror placed in the back of your throat, or a very small, lighted flexible tube (fiberoptic scope) may be passed through your nose in order to view your vocal cords. Videotaping the examination or using stroboscopy (slow motion assessment) may also help with the analysis.


These procedures are not uncomfortable and are well tolerated by most patients. In some cases, special tests (known as acoustic analysis) designed to evaluate the voice, may be recommended. These measure voice irregularities, how the voice sounds, airflow, and other characteristics that are helpful in establishing a diagnosis and guiding treatment.


Diagnostic Procedures:


  • Digital Video-Stroboscopy
  • Flexible Fiberoptic Laryngoscopy
  • Operative Diagnostic Laryngoscopy
  • Transnasal Esophagoscopy
  • FEES Examination
  • Acoustic Analysis of Voice
  • Aerodynamic Analysis
  • Radiologic Testing (CT Scan, MRI)


When should I see an otolaryngologist (ENT doctor)?


  • Hoarseness lasting longer than two weeks especially if you smoke
  • Pain not from a cold or flu
  • Coughing up blood
  • Difficulty swallowing
  • Lump in the neck
  • Loss or severe change in voice lasting longer than a few days


How Are Vocal Disorders Treated?


The treatment of hoarseness depends on the cause. Most hoarseness can be treated by simply resting the voice or modifying how it is used. The otolaryngologist may make some recommendations about voice use behavior, refer the patient to other voice team members, and in some instances recommend surgery if a lesion, such as a polyp, is identified. Avoidance of smoking or exposure to secondhand smoke (passive smoking) is recommended to all patients. Drinking fluids and possibly using medications to thin the mucus are also helpful.


Specialists in speech/language pathology (voice therapists) are trained to assist patients in behavior modification that may help eliminate some voice disorders. Patients who have developed bad habits, such as smoking or overuse of their voice by yelling and screaming, benefit most from this conservative approach. The speech/language pathologist may teach patients to alter their method of speech production to improve the sound of the voice and to resolve problems, such as vocal nodules. When a patients’ problem is specifically related to singing, a singing teacher may help improve the patients’ singing techniques.


The Laryngologist who specializes in vocal disorders is well versed in the abnormalities of the vocal cords. In addition to diagnosing the problem, the laryngologist has many techniques and procedures that can help your voice become more normal.


What Can I Do to Prevent and Treat Mild Hoarseness?


  • If you smoke, quit.
  • Avoid agents that dehydrate the body, such as alcohol and caffeine.
  • Avoid secondhand smoke.
  • Drink plenty of water.
  • Humidify your home.
  • Watch your diet–avoid spicy foods.
  • Try not to use your voice too long or too loudly.
  • Use a microphone if possible in situations where you need to project your voice.
  • Seek professional voice training.
  • Avoid speaking or singing when your voice is injured or hoarse.
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