If your voice has changed or you have become hoarse, it is important that you see your family doctor if this change persists after a few days, particularly if you have not been shouting/overusing your voice or if you have had a cold.
The medical term dysphonia means a change in the voice, including hoarseness, and the similar term aphonia means complete loss of voice (usually reduction to a tiny whisper.)
It is absolutely essential to see your family doctor if you have been hoarse for longer than three weeks, particularly if you are or have been a smoker.
Your family doctor or GP will listen to the story of your hoarseness and any other symptoms you have and will often know your family and medical history. The GP may ask you a number of questions and examine your head and neck and other areas such as your chest, if the GP thinks this is relevant. Most cases of hoarseness are due to viral infections (which do NOT require antibiotics) or overuse of the voice. The problem will get better over a few days and your doctor may advise you to:
- rest your voice and use it gently and sparingly
- drink plenty of liquids, particularly water, and to avoid alcohol, tea and coffee
- stop smoking (preferably forever!)
- take simple painkillers regularly, if necessary (paracetamol or soluble aspirin)
- start or increase antacid medication if acid reflux is thought to be a factor in your case.
Why would your doctor refer me to an ENT surgeon or laryngologist at the hospital?
Most patients with hoarseness do NOT have some damage or disease of their larynx, but instead have problems with the way they are using and often abusing their voice. They are often straining their voice in some way and may additionally be subjecting their larynx to the effects of cigarettes, alcohol, or caffeine. Your family doctor may be concerned by the story of your symptoms, the length of time, or the possible causes or hoarsemess. If these do not fit in with a simple cause which will quickly get better the doctor will refer you to a hospital so that you can have a more detailed assessment and any special examination and tests required. Your doctor will be more inclined to do this if you are a smoker, if you drink excessively or if you rely on your voice to do your job (for instance, if you are a teacher, actor, singer, salesperson, or in a similar role.)
Important factors for referral to hospital are:
- if you have not had a viral infection (e.g. cold or influenza etc.)
- if you smoke/drink
- if your hoarseness has been lasting more than three weeks
- if you have additionally difficulty or pain on swallowing, any lumps in your neck, difficulty breathing or are coughing up blood
What will happen if I need to go to the hospital to see a specialist?
Usually you will be referred to an ENT clinic where an ENT surgeon who may specialise in throat problems – a laryngologist – will assess you. In many ENT departments nowadays the laryngologist works with a speech and language therapist and both will see you together in a specialist voice clinic. Here, they will have all the expertise and equipment required to examine your throat and larynx (voice box) and usually make an accurate diagnosis at this first visit. They can also decide immediately in most cases what is the best treatment for your problem.
If your hospital does not have a specialist voice clinic, the ENT surgeon may see you and make a diagnosis before sending you either to a specialist centre or to a speech therapy department, if that is the treatment you require.
What does the examination of my larynx (voice box) require?
With you comfortably seated, the surgeon or speech therapist will pass a small narrow, highly flexible telescope (fibreoptic endoscope) through your nose and into the back of your throat. This gives the most detailed view of your throat and larynx with its vocal folds. In almost every patient it gives an instant and accurate diagnosis. It also allows the speech therapist and surgeon to ask you to talk/sing/swallow so that they can see your larynx working. This examination in the clinic means that people do not have to be admitted to hospital (as was necessary in the past) and most people only require a small amount of local anaesthetic to be placed in the nose. The examination is NOT painful and even children and the most nervous adults can be successfully examined without distress.
Depending on the cause of your hoarseness or voice change, the following treatments may be necessary and these will be explained to you by your specialists. The majority of patients attending a voice clinic require treatment by a speech therapist,surgery is only occasionally required and is often undertaken after, or in combination with speech therapy.
Speech therapy
The therapy is aimed to restore the best possible voice for the patient. This begins with educating all the patients in how to care for their voice (vocal hygiene) and helping the patient to understand the lifestyle factors and any stresses which have led to the hoarseness. Reduction or removal of these factors is often essential in restoring a good voice and the therapist is able to continuously monitor and measure the patient’s progress.
Voice therapy may involve additional advice about posture and body position and breathing exercises. Voice exercises may be given that are specific to each patient depending on the problem.
Occasionally direct massage to the muscles of the neck around the larynx (manual therapy) is used to relax excessive tension in this area.
This therapy requires the patients understanding and cooperation to be successful, particularly in those patients who have had problems for many months or years and where factors such as stopping smoking or alcohol abuse are very important.
Surgery
Surgery is only required in the minority of patients with hoarseness or change in their voice. A list of possible procedures is discussed in the adjacent patient information section of this website entitled Hoarseness or Change in Voice.