The voice box (or larynx) is the gateway into the lungs and contains the vocal cords which part when you breathe in or out. If they are brought together when you breathe out, they vibrate, and it’s this vibration that generates your voice. Hoarseness (or dysphonia) refers to an alteration in the sound of your voice.
Hoarseness usually occurs because of either a change in the surface lining of the vocal cords or a change in their motion. Often there are other symptoms that are associated with hoarseness such as cough or throat pain.
Most causes of hoarseness are short-lived and usually resolve without the need for medical or surgical intervention.
I would like to see you urgently if your hoarseness has lasted more than 2 weeks particularly if you have the following associated features:
You can be rest assured that I have many years of experience in managing the full breadth and depth of both benign and cancerous conditions of the voice box, windpipe and the swallowing apparatus.
It is vitally important I obtain a detailed, amplified view of your voice box. I will pass a lubricated flexible endoscope with a high definition camera at its end, through your nose and into your throat. This will be broadcast onto a large video screen where you and I will both be able to see the surface detail and movements of your vocal cords.
I will perform a video-stroboscopic assessment on every hoarse patient I review. A video-stroboscopy test visually slows down the vibration and surface contact of the vocal cords as they meet each other. This is a very important part of the examination because it allows me to identify subtle imperfections on the vocal cord surface caused by scar or buried cysts for example, that may not be immediately apparent with a simple endoscopic examination.
Sometimes the camera allows me to visualise the subglottis and upper trachea, areas that lie immediately underneath the vocal folds. Swelling or a lesion in this area may be relevant to some conditions that affect your voice.
Further tests may include a high-resolution CT scan of the voice box windpipe and chest and an MRI scan of the neck.
The myriad of different conditions causing a hoarse voice have unique treatment options. I will discuss the specifics in detail with you at the consultation; however, there are some important general principles of management that I commonly employ for all voice conditions
Many conditions just need medicines such as a course of antibiotics and anti-inflammatory preparations. Any exacerbating conditions that irritate the voice box such as gastroesophageal reflux or rhinosinusitis should be treated on their own merit.
An operation is required to excise discrete lumps on the vocal cords. If I am suspicious of a cancerous lesion, a biopsy will be performed.
I will usually perform a microlaryngoscopy. This involves placing a metal tube through the mouth to obtain a magnified view of the voice box under a microscope. It involves a short general anaesthetic and, in most cases, ventilation without the need for a tube (jet ventilation); this set up affords me unobstructed access to your voice box and windpipe.
It Is vitally important that an ENT surgeon with a specialist interest in laryngology and complex airway reconstruction (or both), manage your voice box. An inappropriate operation risks worsening the voice through damaging scar tissue formation.
I have numerous years of experience in using fine dissecting instruments and laser technology to cleanly remove vocal cord lesions whilst preserving the delicate normal surrounding structures.
Other treatments I may offer include injection of steroid, Botox and filler material and sometimes placement of a permanent implant through an open neck approach (thyroplasty).
I have a specialist interest in the management of complex voice-box and upper airway conditions, including narrowed and scarred airways from trauma and surgery performed by other surgeons. These require specific surgical techniques and approaches.
A very important aspect of voice treatment includes collaborative work with a speech therapist. Speech therapists are experts in rehabilitating voice disorders through focussed voice-physiotherapy. This is important, because many patients develop tension in the muscles of the voice box and abnormal compensatory behaviours that need to be corrected to give an optimal outcome.
This is extremely important for professional Voice users such as singers, broadcasters and teachers.
I and my speech therapy colleagues will provide you comprehensive guidance on vocal hygiene measures to look after your voice box before, during and long after any treatment we recommend.