Hoarseness: When is it Serious?


It’s happened to all of us: we become hoarse and “lose our voice.” For me, it’s usually during college football season – funny thing is, it happens to me whether my Wolverines win or lose; I still manage to find a reason to yell (too much) while watching them play!

There are various reasons why we lose our voice. Sometimes, it’s from yelling at a ballgame or attending a loud concert, and sometimes, we just wake up hoarse for no apparent reason. There are also some among us who seem to perpetually have the Sunday morning, post-bar-outing voice. Unfortunately, I also see the occasional patients who have lost their voice for a more serious reason: cancer of the vocal cords.

So, how does one know whether to wait out the hoarseness or make an appointment to get it checked out?

If it’s apparent that your voice was just fine before you strained it for whatever reason and you became hoarse afterward, there is a very high likelihood that the cause is just vocal cord edema (swelling). When you scream and yell, your vocal cords literally bang together. After hours of such stress, they start to swell – just like if you clapped your hands hard for hours straight, they would swell. In this case, the swelling eventually subsides. As with all swelling of this type, the less you use the affected body part – in this case, your voice – the faster the swelling goes down. After a few days of voice rest, it usually returns to normal.

If your weekend activities are routinely making you hoarse, however, the voice will not bounce back from the abuse as quickly and eventually, it will not bounce back as well, leaving you chronically hoarse. What happens in this case is that the lining of the vocal cords is becoming thickened. Going back to the hand-clapping analogy, the chronic trauma to the hands would eventually cause callouses; this is what nodules are: callouses on the vocal cords. People often ask about just removing these benign growths. What I tell them is this: giving a guy who does hard, manual labor a manicure for his callouses will help for a short time, but as soon as he returns to his regular work, they come back. In the same way, doing an excision of vocal cord nodules may help for a short time, but if the person does not change their voice use, the nodules come back, and repeat surgery will cause more scar tissue, which is irreversible. These chronically hoarse people need to consult with a speech therapist to learn how to avoid abusing their voice.

If there is no apparent reason for voice change and it persists for more than a month, it’s time to get it checked out. With a simple scope procedure in my office, I can see the vocal cords and rule out a serious issue. Oftentimes, the cause of chronic hoarseness in a non-smoker is acid reflux, and treating that condition will help these folks.

Obviously, smokers are at high risk of developing vocal cord cancer and a problem with hoarseness should be checked out as soon as possible. Treating vocal cord cancer is much, much more successful when it is addressed earlier rather than later. Early detection and treatment carries with it a 90% cure rate. Of course, that rate applies to patients who STOP smoking.

If there is no apparent reason for voice change and it persists for more than a month, it’s time to get it checked out.


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