Monday Medical: Help for hoarseness, raspy voice


Professional singers, sportscasters and trial attorneys appreciate a good larynx, or voice box, because it's their money maker.

Well-known Steamboat Springs resident and national sportscaster Verne Lundquist explains it well: "A year ago, I was scheduled to announce nine games in a week, each requiring two-and-a-half hours of strenuous vocalization," he said. "As sportscasters, we refer to ourselves as 'talking dogs.' A 'talking dog' without a real voice is in trouble."

Most of us take this sophisticated instrument, our voice box, for granted until it fails, usually due to hoarseness. This condition is defined as any alteration to the voice - raspiness, strain, pitch change or volume change.

Hoarseness almost always results from a physical abnormality of the vocal cords, a pair of ribbons that remain open for breathing and closed to produce normal sound. Swelling or lumps in the vocal cords alter their movement and vibration, affecting the quality, volume and pitch of one's voice.

Most cases of hoarseness are temporary and not serious. The most common cause is acute laryngitis. Either an upper respiratory tract viral infection (cold) causes swelling of the vocal cords, or excessive voice use such as screaming or cheering causes irritation.

Time, voice rest, humidity and warm liquids provide the cure. Antibiotics are not effective because acute laryngitis is not caused by bacteria.

Vocal nodules ("singer's nodules") may be the cause of more prolonged hoarseness. There usually is a history of improper voice use such as vocalizing too loudly, with the wrong pitch, too often or with too much tension.

For singer's nodules, early intervention with speech therapy is preferred. Rarely, surgery may be necessary if the nodules have been present for a long time.

Laryngopharyngoreflux (LPR) is a frequent cause of hoarseness, throat clearing, dry tickling cough and sensation of mucus on the back of the throat. Stomach acid comes up the esophagus and splashes the vocal cords.

This reflux can be controlled or limited by lifestyle and diet changes such as not lying down soon after eating, avoiding spicy, acidic and fattening foods, and limiting alcohol and caffeine. Frequently, medications such as antacids and proton pump inhibitors (e.g., Prilosec or Nexium) are necessary.

Smoking, allergies and thyroid disorders also may cause changes to the vocal cords resulting in hoarseness.

Penny Copeland works for Yampa Valley Medical Associates in Steamboat Springs.

"I talk a lot over the phone as a medical receptionist," she explains. "My hoarseness was horrible, and I'd choke on my own saliva. With diet changes and medication, I am fine now."

When hoarseness lasts longer than two weeks, it should be evaluated. A careful history and inspection of the larynx are indicated. The vocal cords are viewed by passing a very small, lighted tube called anasopharyngoscope through the nose and into the larynx. This procedure is well-tolerated by most patients.

While the treatment of hoarseness is tailored to the cause, all patients can benefit from a few simple tips.

- Avoid alcohol, caffeine, spicy and acidic foods, tobacco and secondhand smoke.

- Drink plenty of water and humidify your home.

- Try not to abuse your vocal instrument by talking too loudly or for too long.

- Use a microphone when you need to project your voice.

- Give your voice a rest when you're hoarse.

If voice changes persist despite trying these tips, contact your physician for an evaluation. Hoarseness has worked only for Rod Stewart.

Maryann Wall, MD is a board-certified otolaryngologist, head and neck surgeon and board-certified facial plastic surgeon practicing in Steamboat Springs.


camarors69 8 years, 11 months ago

Then, there's a situation whereby a right vocal cord paralysis occurs due to bruising of the laryngeal nerve as the result of surgical removal of a bronchial cyst. It's an unexpected, temporary outcome, but nonetheless, one that can severly impact one's quality of life. My hat is off to those in the otolaryngologist field.


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