Hoarse Voice (Dysphonia)

For those affected by dysphonia, the voice can be described as hoarse, rough, raspy, strained, weak, breathy or gravely. There may also be voice breaks and pitch changes.

What is Dysphonia?

Dysphonia refers to having an abnormal voice. It is also known as hoarseness. Dysphonia has many causes which are detailed below. Changes to the voice can occur suddenly or gradually over time. The voice can be described as hoarse, rough, raspy, strained, weak, breathy, or gravely. There may be voice breaks where the voice completely stops or cuts out. There may be pitch changes, either higher or lower for the patient. The patient may have a complete loss of voice for a period of time as well. Sometimes the patient will complain of pain with speaking or singing and difficulty projecting the voice. Most commonly, dysphonia is caused by an abnormality with the vocal cords (also known as vocal folds) but there can be other causes from problems with airflow from the lungs or abnormalities with the structures of the throat near the vocal cords.

How is dysphonia assessed?

The best assessment for dysphonia is done by an Otolaryngologist (Ear, Nose, and Throat physician) that treats voice disorders in conjunction with a speech pathologist. Obtaining an accurate history of when the dysphonia began and what the voice complaints are, along with listening to the voice, help the physician and speech pathologist in understanding the voice disorder. A voice assessment is performed by the speech pathologist where the patient or parent provides answers to how the dysphonia is affecting daily activities. The patient is also asked to speak into a microphone which records the voice and obtains measures that are compared to voice standards. A physical exam is important to visualize any abnormalities with the anatomy of the vocal cords. This exam (Flexible Laryngoscopy or Video Stroboscopy) is best done with a flexible tube with a camera attached called a laryngoscope. This flexible tube is passed gently through the nose to the back of the upper throat to avoid gagging and allows the physician and speech pathologist to visualize the entire throat and vocal cords. This exam is video recorded so that the physician, speech pathologist, parent, and patient can visualize the structures of the throat and determine if there is a problem causing the abnormal voice. This exam is well tolerated in all ages and takes 1-2 minutes to complete in the clinic.

What are the causes of dysphonia?

There are numerous causes of dysphonia which are detailed below in the following common categories:

  1. Inflammation:
    • Laryngitis: Swelling of the vocal cords from over use of the voice or a viral illness
    • Allergy: Swelling of the vocal cords from cough, post-nasal drip, sneezing
    • Laryngopharyngeal reflux: Stomach reflux causing swelling and irritation of the delicate tissues of the vocal cords and throat
  2. Growths on the vocal cords:
    • Vocal cord nodules: Small calluses on the vocal cords from overuse of the voice or vocal cord injury that occurs with yelling
    • Vocal cord polyps: Small growth on the vocal cord that is like a blister from overuse of the voice or vocal cord injury during yelling
    • Vocal cord cyst: Small growth on the vocal cord that is typically filled with mucous and causes a rough and raspy voice
    • Vocal cord papilloma: Small warts on the vocal cords that are caused by exposure to a specific virus called the human papilloma virus
  3. Scarring of the vocal cords
    • Patients can develop scarring of the vocal cords from trauma/injury to the vocal cords or from previous breathing tubes being in place for surgery or while on a ventilator.
  4. Vocal cord paralysis
    • Patients can be born with a weak vocal cord or develop weakness with movement of the vocal cords from a nerve injury. The patient will often have a raspy voice that is weak or breathy.

What are the treatments for dysphonia?

The patient and parent need to understand how to properly use the voice in order for treatments to be effective. Most voice disorders are treated with some form of voice therapy by a licensed speech pathologist that focuses on care for voice problems. Surgery is sometimes necessary for certain voice disorders. The physician may prescribe medication to help with inflammation of the vocal cords when this is present.

How can I prevent dysphonia?

Understanding how to effectively use the voice without injuring the vocal cords is most important. Drinking adequate water daily, avoiding cough and throat clearing, and using the voice appropriately without yelling or abusing the voice can help prevent dysphonia.

When should I seek evaluation for dysphonia?

Any patient that has changes to their voice that lasts for longer than three weeks and does not seem to be improving should have a complete voice evaluation.