Examination and Investigations, Causes and treatment for Hoarseness

Examination and Investigations, Causes and treatment for Hoarseness

Hoarseness typically gives the voice a raspy and harsh quality, though it may also cause a change in the pitch or volume of the voice. The rapidity of onset and any associated symptoms will depend on the underlying cause leading to hoarseness.


Hoarseness is defined as roughness of voice, which results from an abnormality within the larynx with variation in periodicity, and intensity of consecutive sound waves.
Patho-physiology Of Hoarseness:
For the normal production of voice vocal cords should be able to approximate properly with each other, have a proper size and stiffness and have an ability to vibrate in response to air column. Any condition that interferes with these functions may cause hoarseness. Loss of approximation may be seen in vocal cord paralysis, fixation of crico-arytenoid joint or any lesion present between the cords, preventing its approximation. Size and stiffness of the vocal cords may change due to paralysis, edema, tumor, fibrosis and partial surgical excision. Cords are unable to vibrate properly in the presence of edema, congestion, sub-mucosal hemorrhage, nodule, polyp or tumor.

Causes of Hoarseness:

Hoarseness may be acute (less than few weeks in duration) or chronic (more than few weeks in duration) in type.
The causes of acute hoarseness are:
Acute inflammation Acute laryngitis
Acute laryngo-tracheo-bronchitis
Laryngeal diphtheria
a- Vocal abuse
Foreign body in the larynx
Inhalation of irritant fumes
Cut throat
Intubation & other instrumentation
External injury to larynx
Sudden paralysis of vocal cords
After thyroidectomy
Trauma to recurrent laryngeal nerve
Other neurological conditions like CVA
Laryngeal edema due to allergy
Functional e.g. psychosomatic, hysteria

The causes of chronic hoarseness are:

Laryngeal web
Congenital laryngeal paralysis
Congenital cysts and tumors
Chronic Inflammation e.g., Chronic laryngitis
Laryngeal tuberculosis c- Other chronic inflammations e.g. Syphilis
Intubation granuloma
Vocal nodules
Tumors of larynx: benign and malignant
Vocal cord paralysis
Vocal cord polyp
Sometimes weakness of voice is present which is not true hoarseness, as in:
Myasthenia gravis
General debility
Functional dysphonia
Covalescence from severe illness 

Management Of Patient with Hoarseness

History: Mode of onset and duration of Hoarseness is very important. Any hoarseness persisting for more than three weeks requires thorough examination and investigations and the malignancy should be excluded first, especially in patients above forty years of age. Patient’s occupation, habits and associated complaints should be noted to find the cause.
Examination: Examination of the larynx by indirect laryngoscopy or flexible laryngoscopy is very helpful. Examination of the neck, oral cavity, nose and chest must be done thoroughly.
Investigations: Laboratory and radiological investigations should be done accordingly. Direct laryngoscopy examination and biopsy of any lesion may be needed.

How are the causes of hoarseness diagnosed?

A health care professional will ask the patient questions about their hoarseness and any other associated symptoms. A physical exam will focus on the head and neck. Often times, a diagnosis can be made based on this initial assessment. In some instances, a long lighted flexible tube (fiberoptic scope) will be inserted into the throat to directly visualize the vocal cords if no other cause is initially identified. Individuals with hoarseness that lasts longer than 2 to 3 weeks should have a consultation with an otolaryngologist in order to exclude any serious causes of hoarseness.

Treatment for hoarseness

The treatment for hoarseness depends on the underlying cause, for example:

Acute laryngitis caused by an upper respiratory tract infection will usually improve on its own as the infection clears the body. Conservative treatment with cough suppressants and humidified air can be helpful.
Voice rest is also recommended in order to avoid further irritation or injury to the vocal cords.
Antibiotics are not indicated for most cases of acute laryngitis.
Smoking cessation is suggested for those individuals that smoke.
Individuals with hoarseness caused by vocal overuse or misuse should adhere to voice rest, as serious injury (such as vocal cord hemorrhage can occur to the vocal cords if the voice is strenuously used during episodes of acute laryngitis.
Medications for gastroesophageal reflux (GERD) or allergies can treat hoarseness if either of these is found to be the underlying cause.
In some instances, surgery may be necessary for benign nodules or polyps, trauma to the larynx/vocal cords and for cancer of the larynx.