ENT London Blog

What do we mean by “hoarse voice”?

“Hoarse voice”is a term used to describe the symptom where there has been a change in the quality of the voice. It is not a diagnosis.

Hoarseness is usually caused by abnormalities in the larynx, resulting in abnormal vocal cord vibration.

What is the larynx?

The larynx is an organ made up of various cartilages (eg epiglottis, thyroid, cricoid, arytenoids) which is bound together by ligaments and muscles, and lined with respiratory mucous membrane (except the vocal cords which are lined by stratified squamous epithelium). The larynx is situated anteriorly in the neck, between the base of tongue and trachea.

The most important function of the larynx is that it protects our airway when we swallow. It also enables us to produce vocal sounds, as well as cough and strain (ie a mechanical advantage—try lifting something heaving without holding your breath!)

Common causes of hoarse voice?

Most people have had or will develop a hoarse voice at some stage in their lives. The cause is oten multifactorial, and in the majority of people there is no identifiable disease.

Inflammatory – eg acute and chronic laryngitis
Acute laryngitis is seen frequently in primary care, and is usually associated with other symptoms of an upper respiratory tract infection.

Chronic inflammation may be the result of persisting vocal abuse or contact with irritants such as smoke, alcohol, acidic gastric contents (GORD) or other chemicals inhaled or consumed. In some individuals, the laryngeal mucosa may become dysplastic, a potentially pre-malignant condition. The vocal cords, in particular, are a vulnerable site to change.

Neoplastic – eg laryngeal papillomatosis, laryngeal carcinoma

Laryngeal papillomatosis is typically seen in children rather than adults. Warty lesions may affect the trachea-bronchial airways, and are believed to be caused by the human papillom virus.

Laryngeal carcinoma is the commonest head and neck cancer, accounting for up to 2% of all cancer deaths. The majority are squamous cell carcinomas, and over half of them arise from the vocal cords (ie glottis) where hoarseness is the first presenting symptom.

Voice abuse

This may be an acute or chronic problem (eg shouting too much) and may result in structural changes within the larynx, such as:

a non-infective laryngitis, where the vocal cords become inflammed.

vocal cord nodules also called “singer’s” or “screamer’s” nodules, typically form in a symmetrical pattern at the junction of the anterior third and posterior two thirds of both vocal cords. It is at this site on the cords that maximum trauma occurs during loud high pitched vocals.

ENT London is one of UK’s leading Nose Surgery London clinics, and can be contacted on 0207 580 6970.

admin | Patient Information | 01 7th, 2009 |

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