Hoarseness of voice

Overview of Hoarseness of voice

For production of normal voice, vocal cords should i.e.:

1. Be able to approximate properly with each other.
2. Have a proper size and stiffness.
3. Have an ability to vibrate regularly in response to air column.

Any condition that interferes with the above functions causes hoarseness.

(a) Loss of approximation may be seen in vocal cord paralysis or fixation or a tumour coming in between the vocal cords.

(b) Size of the cord may increase in oedema of the cord or a tumor; there is a decrease in partial surgical excision or fibrosis.

(c) Stiffness may decrease in paralysis, increase in spastic dysphonia or fibrosis. Cords may not be able to vibrate properly in the presence of congestion, submucosal haemorrhages, nodule or a polyp.[1]

Causes of Hoarseness of voice

Inflammations i.e.

• Acute i.e.

Acute laryngitis usually following cold, influenza, exanthematous fever, laryngo-trachea-bronchitis, diphtheria

• Chronic i.e.

(i) Specific- Tuberculosis, syphilis, scleroma, fungal infections

(ii) Nonspecific- Chronic laryngitis, atrophic laryngitis

Tumors i.e.

• Benign: Papilloma (solitary and multiple), Haemangioma, Chondroma, Fibroma, Leucoplakia
• Malignant: Carcinoma Tumor-like masses Vocal nodule, Vocal polyp, Angiofibroma , Amyloid tumor ,Contact ulcer, Cysts, Laryngocele

Trauma i.e.

Submucosal haemorrhage, laryngeal trauma (blunt and sharp), foreign bodies, intubation

Paralysis i.e.

Paralysis of recurrent, superior laryngeal or both nerves

Fixation of cords i.e.

Arthritis or fixation of cricoarytenoid joints

Congenital Laryngeal web i.e.

Cyst, laryngocele

Miscellaneous i.e.

Dysphonia plica ventricular is, myxoedema, gout

Functional intense aphonia

Classification of Hoarseness of voice

1. Functional Dysphonia or Hoarseness
2. Organic Dysphonia or Hoarseness

1.Functional Dysphonia or Hoarseness

• Psychogenic
• Vocal misuse
• Idiopathic

2.Organic Dysphonia or Hoarseness

• Laryngitis (Acute i.e.: viral, bacterial) – (Chronic i.e.: smoking, GERD, LPR)
• Neoplasm (Premalignant i.e.: dysplasia) – (Malignant i.e.: Squamous cell carcinoma)
• Trauma (Iatrogenic i.e.: surgery, intubation) – (Accidental i.e.: blunt, penetrating, thermal)
• Endocrine (Hypothyroidism, hypogonadism)
• Hematological (Amyloidosis)
• Iatrogenic (inhaled corticosteroids)

Risk Factors

Hoarseness of voice, also known as dysphonia, can be caused by a variety of factors, including:

• Vocal abuse: This includes excessive talking, shouting, screaming, or singing, especially in a strained or forceful manner.
• Laryngitis: This is an inflammation of the larynx, often caused by a viral or bacterial infection.
• Vocal cord nodules or polyps: These are benign growths on the vocal cords that can interfere with their vibration
• Acid reflux: This is a condition in which stomach acid flows back up into the esophagus, and can irritate the vocal cords.
• Smoking: This is a major risk factor for hoarseness, as it irritates the vocal cords and can lead to the development of cancer.

• Alcohol consumption: This can dehydrate the vocal cords and make them more susceptible to damage.
• Allergies: These can cause inflammation of the vocal cords, leading to hoarseness.
• Neurological disorders: These can affect the nerves that control the vocal cords, leading to hoarseness.
• Thyroid problems: These can affect the function of the vocal cords, leading to hoarseness.
• Cancer of the larynx: This is a serious condition that can cause hoarseness, as well as other symptoms.

A comprehensive resource on voice disorders, including hoarseness, is the book "Voice Disorders" by Dr. Robert Thayer Sataloff. This book provides detailed information on the causes, diagnosis, and treatment of various voice disorders, including the risk factors associated with hoarseness.

It is important to note that this is just a partial list of the risk factors for hoarseness. If you are experiencing hoarseness that lasts for more than two weeks, it is important to see a doctor to determine the cause and get appropriate treatment.[4]

Sign & Symptoms of Hoarseness of voice

• Changes in voice pitch: Your voice may become lower or higher than usual.
• Reduced vocal volume: You may find it difficult to speak loudly or project your voice.
• Voice fatigue: Your voice may tire easily after speaking for a short period.
• Breathy or strained voice: Your voice may sound airy or as if you are straining to speak.
• Loss of vocal range: You may have difficulty hitting high or low notes when singing.
• Tickling or scratchy sensation in the throat: You may feel a constant urge to clear your throat.
• Dry cough: A persistent dry cough can accompany hoarseness.
• Pain or discomfort in the throat: Speaking may become painful.

Diagnosis of Hoarseness of voice

1. History- Mode of onset and duration of illness, patient’s occupation, habits and associated complaints are important and would often help to elucidate the cause. Any hoarseness persisting for more than 3 weeks deserves examination of larynx. Malignancy should be excluded in patients above 40 years.
2. Indirect laryngoscopy- Many of the local laryngeal causes can be diagnosed.
3. Examination of neck, chest, cardiovascular and neurological system would help to find cause for laryngeal paralysis.
4. Laboratory investigations and radiological examination should be done as per dictates of the cause suspected on clinical examination.
5. Direct laryngoscopy and micro laryngoscopy help in detailed examination, biopsy of the lesions and assessment of the mobility of cricoarytenoid joints
6. Bronchoscopy and esophagoscopy may be required in cases of paralytic lesions of the cord to exclude malignancy.[1]

Treatment of Hoarseness of voice

Voice therapy

Indirect therapies i.e.

• Indirect therapies take into account external factors that may influence vocal production.
• This incorporates maintenance of vocal hygiene practices, as well as the prevention of harmful vocal behaviors.
• Vocal hygiene includes adequate hydration of the vocal folds, monitoring the amount of voice use and rest, avoidance of vocal abuse and taking into consideration lifestyle choices that may affect vocal health (e.g., smoking, sleeping habits).
• Vocal warm-ups and cool-downs may be employed to improve muscle tension and decrease risk of injury before strenuous vocal activities.
• It should be taken into account that vocal hygiene practices alone are minimally effective in treating dysphonia, and thus should be paired with other therapies. 

Medication and surgery i.e.

• Medical and surgical treatments have been recommended to treat organic dysphonia’s.
• An effective treatment for spasmodic dysphonia (hoarseness resulting from periodic breaks in phonation due to hyperadduction of the vocal folds) is botulinum toxin injection.
• The toxin acts by blocking acetylcholine release at the thyro-arytenoid muscle.
• Although the use of botulinum toxin injections is considered relatively safe, patients’ responses to treatment differ in the initial stages; some have reported experiencing swallowing problems and breathy voice quality as a side-effect to the injections.
• Breathiness may last for a longer period of time for males than females.
• Surgeries involve myomectomies of the laryngeal muscles to reduce voice breaks, and laryngoplasties, in which laryngeal cartilage is altered to reduce tensions.

Homeopathic Treatment of Hoarseness of voice

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Hoarseness of voice:

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Medicines:  

Antim Crud

• Loss of voice from getting overheated.
• Aggravation either from heat of sun or from getting warm; after rest.[2] 

Arum Triphyllum

• Voice suddenly gives out during use from lack of control over vocal cords.
• Aggravation either from talking or singing; voice uncertain and changing continually.
• Sometimes deep and hollow, and then again loud also screeching. copious secretion also great accumulation of mucus in trachea.

Argentum Nitricum

• Chronic laryngitis of singers, raising the voice causes cough.
• Internal soreness of larynx also pit of throat.
• Aggravation in mornings; hoarseness, with sensation as if something were clogging the vocal organs, even loss of voice.

Belladonna

• Hoarseness, especially violent when crying.
• Hoarse, rough voice, with dryness also painfulness in larynx.
• Sudden attacks of hoarseness, feeble voice, dry cough, often with spells of suffocation.
• Speaking difficult only in a piping tone.[2]

Calcarea Carb

• Hoarse, hardly audible voice, aggravation in mornings also relieve by hawking.
• Larynx often becomes dry.
• Persons who must talk a great deal become subject to hoarseness also pain and weakness in chest.

Carbo Veg

• Hoarseness recurring regularly every evening, with raw feeling down larynx also trachea and dry tickling, sometimes spasmodic cough.
• Aggravation after exposure to damp, warm evening air.
• Ulcerative soreness in larynx and burning pain in lungs after a hard cough, aggravation in evening and night, often disappearing in the morning.
• Deep voice, failing if exerted; unusual feeling of dryness in trachea, not relieved by hawking; after measles [2]

Custicum

• Hoarseness, aggravation in morning also after exposure to dry, cold, severe winter weather, with scraping burning and rawness in larynx and chest, accompanied by a dry, teasing cough.
• Paresis of laryngeal muscles also vocal cords, cannot speak a loud word.
• Voice reverberates in head; hoarseness in public speakers also singers from straining vocal organ.
• Rattling of phlegm in throat also chest, aggravation in evening to midnight.

Chamomilla

• Hoarseness or loss of voice in children, with rough cough; additionally stitching burning pains in throat.
• Sensation of rawness also scraping in larynx.
• Hoarseness on account of tough mucus in larynx, which can only be removed especially by strong hawking.
• Catarrhal hoarseness of trachea, with dryness of the eyelids.

Drosera

• Voice hoarse, deep, husky, hollow, requires exertion to speak; chest also throat.
• Symptoms worse either from talking or singing.
• Sensation as if something in chest prevented exhalation when talking or singing.

Graphitis

• Hoarseness in singers when they cannot control their vocal cords.
• They become hoarse as soon as they begin to sing also their voice cracks.
• Aggravation in evening; soreness and roughness of larynx also tickling cough, especially in those who exert their voice a great deal.

Kali Bichromicum

• Subacute and chronic inflammatory process either in larynx or bronchial tubes, with congestion and swelling of the tubes.
• Increased secretion of a glutinous mucus which veils also alters the voice.[2]

Diet & Regimen of Hoarseness of voice

• Give rest to voice box
• Drink more fluid
• Warm water to reduce inflammation

Do’s and Don’ts 

Hoarseness of voice 

Do’s:

• Rest your voice: Avoid talking or singing excessively, especially when your voice feels strained.
• Stay hydrated: Drink plenty of water throughout the day to keep your vocal cords lubricated.
• Humidify the air: Use a humidifier to add moisture to the air, especially in dry environments.
• Gargle with warm salt water: This can help soothe irritated vocal cords.
• Suck on lozenges or hard candy: This can help to stimulate saliva production and keep your throat moist.
• Use over-the-counter pain relievers: If you have throat pain, over-the-counter pain relievers like ibuprofen or acetaminophen may help.
• See a doctor: If your hoarseness lasts for more than two weeks, or if you have any other concerning symptoms, see a doctor.

Don’ts:

• Whispering can strain your vocal cords more than normal speech.
• Don’t clear your throat excessively: This can irritate your vocal cords.
• Don’t smoke: Smoking irritates the vocal cords and can lead to long-term damage.
• Avoid Alcohol: Alcohol can dehydrate your vocal cords and make them more susceptible to damage.
• Don’t shout or scream: This can put a lot of strain on your vocal cords.
• Don’t use decongestants: Decongestants can dry out your vocal cords.

If you have hoarseness, it is important to take steps to protect your voice and give it time to heal. By following these do’s and don’ts, you can help to speed up the healing process and prevent further damage to your vocal cords.

References

1.  Diseases_of_Ear_Nose_and_Throat_6Edition
2.  Homoeopathic Therapeutics by Lilienthal
3. Hoarseness – It’s spectrum, associations and management in a tertiary care centre in India (2022)
4. Voice Disorders Book by Robert Thayer Sataloff, 4th Edition, Robert Thayer Sataloff,2010, Plural Publishing.
5. Professional Voice: The Science and Art of Clinical Care,4th Edition,Ingo R. Titze, Katherine Verdolini,Abbott,2012,Plural Publishing.
6. Practical Approach to Voice Problems,1st Edition,Alison Behrma,2012,Plural Publishing.
7. Cummings Otolaryngology: Head and Neck Surgery, 7th Edition, Paul W. Flint, Bruce H. Haughey, Valerie J. Lund, John M. Niparko, Mark A. Richardson, K. Thomas Robbins, J. Regan Thomas,2020,Elsevier.
8. The Voice Book: Caring For, Protecting, and Improving Your Voice,1st Edition,Kate DeVore,2009, Random House Reference.
9. Clinical Voice Pathology: Theory and Management by Joseph C. Stemple, Leslie E. Glaze, and Bernice K. Gerdeman

Also Search As

Start with trusted medical websites:

• National Institutes of Health (NIH): The NIH website (nih.gov) offers extensive information on various health topics, including hoarseness. Look for resources from the National Institute on Deafness and Other Communication Disorders (NIDCD).   
   
• Mayo Clinic: The Mayo Clinic website (mayoclinic.org) provides reliable, up-to-date medical information for the public.
   
• Cleveland Clinic: Another reputable source for medical information, the Cleveland Clinic website (my.clevelandclinic.org) offers articles and resources on hoarseness.
   

2. Use medical databases:

• PubMed: This free resource from the National Library of Medicine provides access to a vast collection of medical literature, including research articles and clinical studies on hoarseness.
   
• Google Scholar: A comprehensive search engine for scholarly literature, Google Scholar can help you find research articles, theses, and books on hoarseness.
   

3. Consult medical professionals:

• Your doctor: If you’re experiencing hoarseness, your primary care doctor is a good starting point. They can provide an initial assessment and refer you to a specialist if needed.
• Otolaryngologist (ENT doctor): ENT doctors specialize in conditions of the ear, nose, and throat, including voice disorders. They can diagnose the cause of your hoarseness and recommend appropriate treatment. 
   
• Speech-language pathologist: If your hoarseness is related to voice misuse or a voice disorder, a speech-language pathologist can help you improve your vocal habits and techniques.
   

Tips for effective searching:

• Use specific keywords: Include terms like "hoarseness," "dysphonia," "voice disorders," "laryngitis," and any other relevant symptoms you’re experiencing.
• Refine your search: Use filters to narrow down your results by date, publication type (e.g., review articles, clinical trials), or source (e.g., medical journals, government websites).
• Look for credible sources: Pay attention to the author’s credentials, the website’s reputation, and the date of publication.
• Cross-reference information: Don’t rely on a single source. Compare information from multiple reputable sources to ensure accuracy.
  

  Other ways

1. Specialized Homeopathic Resources:

• Homeopathic Journals: Look for articles in journals like "The American Journal of Homeopathic Medicine," "Homeopathy," or "The British Homeopathic Journal." Many of these journals have online archives you can search.
• Homeopathic Organizations: Check the websites of organizations like the National Center for Homeopathy or the North American Society of Homeopaths. They often have articles and resources for the public.
• Homeopathic Libraries: Some libraries specialize in homeopathy. See if there’s one near you, or if any have online catalogs you can search.

2. Databases with a Focus on Alternative Medicine:

• PubMed: While it’s a general medical database, PubMed does include articles on alternative medicine, including homeopathy. You can use filters to focus your search.
• Google Scholar: Use advanced search operators in Google Scholar to look for articles that mention both "hoarseness" and specific homeopathic remedies.

3. Combine Your Search Terms:

• Be specific: When searching, use terms like "homeopathy," "hoarseness," "dysphonia," "laryngitis," and the names of any homeopathic remedies you’re interested in (e.g., "Causticum," "Phosphorus," "Hepar sulph").
• Look for case studies: Many homeopathic articles are in the form of case studies, where a specific patient’s treatment is described.

4. Evaluate Your Sources:

• Author expertise: Check the author’s qualifications and experience in homeopathy.
• Publication date: Look for recent articles to ensure the information is up-to-date.
• Peer review: See if the article was published in a peer-reviewed journal, which means it was evaluated by other experts in the field