Hoarseness of voice is the loss of sonority of the voice with the appearance of hoarse overtones. The voice becomes tensely choked, low, whispery, monotonous. Hoarseness appears with stress, dehydration, laryngitis, tumors of the vocal folds, burns of the throat, GERD, thyroid disorders, poisoning. Diagnosis includes laryngo- and stroboscopy, electroglottography, CT scan of the larynx, if necessary, X-ray and electrophysiological examination. Treatment can be conservative (inhalations, endolaryngeal instillations, physiotherapy) or surgical (removal of tumors, laryngoplasty). Additionally, phonopedic correction is shown.
The cause of a functional voice disorder - phonasthenia - is excessive overload of the vocal apparatus. Phasthenia is typical for people who use speech as a professional tool: teachers, singers, actors, guides. There is a rapid voice fatigue, which leads to hoarseness, trembling, voice breakdowns. Sometimes there are spasms in the pharynx, soreness and dryness in the throat. Hoarseness can occur when screaming, loud singing, prolonged conversation in raised tones.
Hoarseness of voice - from dysphonia to aphonia - is the most common symptom of various types of laryngitis: catarrhal, hypertrophic, atrophic, specific. In acute forms, phonation disorders are combined with pain when swallowing, burning and sore throat, dry barking cough. Hyperesthesia, pain syndrome and fever lead to a deterioration in overall well-being. Acute catarrhal laryngitis develops with ARVI: parainfluenza, influenza, norovirus and adenovirus infection.
Chronic diseases of the larynx are accompanied by hoarseness, coughing, constant accumulation of mucus. A variety of chronic laryngitis are nodules of the vocal folds. Complaints are made of discomfort in the throat, the inability to control the voice in full range, hoarseness and hoarseness.
Hoarseness and hoarseness of the voice are characteristic of lesions of the larynx caused by infectious pathogens of tuberculosis, syphilis, and scleroma. These diseases occur in the form of specific laryngitis, accompanied by the formation of infiltrates, granulomas in the region of the vocal folds and subglottic space. In the later stages, scarring processes begin, leading to a persistent narrowing of the lumen of the larynx and a change in voice.
In the absence of organic diseases of the vocal apparatus, as an etiological factor in hoarseness, one should think about functional dysphonia. It can take place in various ways:
Hoarseness of voice
Benign neoplasms often develop against the background of chronic laryngitis. Among them, the most common cysts, angiomas, papillomas, fibromas. Hoarseness of voice can be permanent or occur suddenly, when the neoplasm is infringed between the vocal folds. Widespread papillomatosis of the larynx can also cause breathing difficulties. With throat cancer, hoarseness develops only when neoplasia is localized in the vocal folds. Dysphonic symptoms can be combined with dysphagia, shortness of breath.
With acute stenosis of the larynx, hoarseness appears abruptly. Rapidly increasing inspiratory dyspnea, stidor breathing, acrocyanosis. The patient has anxiety and fear of death. Due to the high risk of asphyxia, acute laryngostenosis requires immediate medical attention.
The clinic of chronic stenosis of the larynx unfolds gradually. As the narrowing of the glottis progresses, a phonation disorder occurs: from mild hoarseness to severe hoarseness and even aphonia. Increased shortness of breath and respiratory failure. The causes of laryngostenosis can be a variety of pathological processes:
Neuropathic and myopathic paresis are accompanied by a disorder of phonatory and respiratory function. These conditions are typical for infectious diseases, myasthenia gravis, stroke, compression of the nerve trunks by tumors of the mediastinum, aortic aneurysm, and intraoperative injuries. Various types of voice disorders are observed: a decrease in sonority, hoarseness or aspiratory hoarseness, aphonia. Shortness of breath is aggravated by vocal load. Choking and aspiration of food can join.
With chemical and thermal burns of the throat, a sharp pain syndrome comes to the fore, aggravated by swallowing movements. Typically salivation, hiccups, possible vomiting. There are hoarse notes in the voice. There is a cough, a feeling of lack of air. Subsequent scarring of the larynx often leads to permanent hoarseness. Severe inhalation injury is typical for steam burns, poisoning with ammonia, chlorine, phenol.
Heartburn, chest pain, belching, dysphagia are the most characteristic signs of gastroesophageal reflux. At the same time, in some patients with GERD, extraesophageal symptoms prevail: shortness of breath, arrhythmias, erosion of tooth enamel. Laryngopharyngeal reflux includes recurrent sore throat, coughing, hoarseness, and aphonia. These symptoms are associated both with the direct damaging effect of refluxate, and with reflex cardiac, bronchial reactions.
The condition of the vocal folds - thickness, elasticity, mobility - directly affects the characteristics of the voice. Swelling or loss of elasticity of the ligaments leads to their dysfunction: paradoxical movement, impaired closure and opening. Clinically, this is manifested by signs of dysphonia. Hoarseness of voice is typical for the following conditions:
The appearance of hoarseness requires an urgent visit to an otolaryngologist to determine the cause of the dysphonic disorder. If diseases of the larynx are excluded, in-depth diagnostics may be required with the involvement of other specialists: an endocrinologist, a neurologist, an oncologist.
Endoscopy of the larynx
Targeted therapy is aimed at eliminating the cause of hoarseness. However, this is not always possible to achieve at the pre-medical stage. In the acute stage of inflammation and vocal fatigue, it is necessary to observe the silence mode, to exclude contact with any irritating substances.
In cases where hoarseness of voice is associated with a cold, dry heat on the neck area (scarf, saline heating pad), inhalations, and warm gargles help. Any warming procedures are contraindicated with an increase in body temperature, so you should not self-medicate and postpone a visit to the doctor.
Local ENT procedures are indicated for laryngitis, tonsillitis, phonasthenia. With hoarseness, endolaryngeal instillations of drugs, drug inhalations, and procedures on the Tonsillor apparatus are performed. Antiviral drugs, antibiotics, antiseptic and antihistamines are prescribed.
With paresis of the larynx, GERD, etiotropic drug therapy is selected. In case of severe dehydration and hyperthermia, intravenous infusions of saline solutions are carried out. Physiotherapy (electrophoresis, electrical stimulation, UHF therapy), psychotherapy, and IRT contribute to faster elimination of hoarseness. Foreign bodies in the throat are removed using endoscopic techniques.
With the threat of development of asphyxia due to acute stenosis of the larynx, an emergency tracheostomy or conicotomy is indicated. The presence of tumors that prevent normal breathing and voice formation is an indication for their endolaryngeal removal. In case of malignant neoplasia, a resection intervention is required in the amount of hemilaryngectomy, extended or combined laryngectomy.
If the cause of hoarseness is compression of the recurrent nerve by tumor formations, appropriate surgical interventions are performed: thymectomy, removal of a mediastinal tumor, excision of a retrosternal goiter, etc. With abnormalities in the development of the larynx, cicatricial stenosis, various modifications of laryngoplasty are performed.
If the hoarseness of the voice does not disappear after the elimination of the etiological factor, a course of phonopedic classes is prescribed. In speech therapy classes, phonation and voice exercises, speech therapy massage are used. At the final stage, they automate the skills of correct voice leading, work on increasing strength, restoring timbre, and expanding the range of voice. An important role in the prevention of recurrence of hoarseness and the effectiveness of rehabilitation work is played by compliance with the recommendations of the phonopedist on voice hygiene.