What is Hoarseness of the Voice?

Hoarseness is a general term referring to changes in the voice. Synonyms or other words commonly used include raspy, rough, deep, weak, breathy, or strained. Occasionally, hoarseness can be uncomfortable or associated with other symptoms such as difficulty swallowing or sensation of a lump in the throat. Most causes of hoarseness are benign, but some should be taken more seriously. In general, voice changes lasting more than one month should be evaluated. Causes include acid reflux or laryngopharyngeal reflux, or excess or prolonged voice use. Certain risk factors including a history of tobacco use increase one’s alertness to a possible growth or cancer of the vocal cord.

Stroboscopy is the most advanced method to evaluate hoarseness by gently inserting a camera through the nose or mouth and visualizing the vocal cords. There are a pair of vocal cords which sit low in the throat and are protected by the voice box. Stroboscopy is performed by a laryngologist, who is a fellowship trained specialist in voice and swallowing conditions. Stroboscopy is quite remarkable in that it can reveal gross abnormalities on the vocal cords including a nodule, polyp, cyst, swelling or growth. But its utility truly shines by detecting small changes in the vibration of the vocal cords such as a scar, mild weakness, or age-related thinning or shrinkage.

Fortunately, modern medicine has provided us with the ability to evaluate, detect, and treat hoarseness early in its course. Medications are used for some conditions. For others requiring procedural intervention, minimally invasive lasers and even fillers (similar to those used in the face) can be applied to the vocal cord in awake patients in the office, avoiding the need for general anesthesia. Remarkably, these procedures are tolerated well.

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