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hoarseness

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Hoarseness is a voice disorder: those who are hoarse typically have a smoky, rough voice with limited volume. Sometimes the voice is completely gone: then only a whisper is possible. How do you get hoarse and what helps against it?

The human voice is mainly created in the larynx, which is located at the top of the windpipe. In the larynx there are two vocal folds, the free edges of which form the vocal cords. When speaking, the vocal folds come together and almost completely close the glottis. When air flows through this gap when you exhale, the vocal folds begin to vibrate and produce sounds. Hoarseness arises when this process is impaired.

Hoarseness can have many different causes. If the voice sounds hoarse or is completely gone,

  • there may be organic changes in the larynx or non-organic reasons,
  • which can be both harmless and serious.

But hoarseness is usually harmless and disappears again after a short period of time.

Because even when breathing in room air that is too cold, too dry or too warm it can happen that the voice sounds hoarse for a short time. In addition, drinking too little can lead to hoarseness.

Organic causes

The most common cause of hoarseness is inflammation in the area caused by a virus or bacteria

Such inflammations occur mainly in the context of colds and flu. Then the throat feels rough and dry at the same time, the throat scratches and you have to clear your throat often. Due to the inflammatory reaction, the vocal folds can no longer vibrate freely - hoarseness is the result. Once the infection has been overcome, the voice will usually sound normal again.

Laryngitis with hoarseness can also occur without a cold or other infections. Instead, external stimuli can be behind it. A typical example of this is smoking. And even if acidic gastric juice flows back up the esophagus and irritates the larynx, the voice can become hoarse. Then there is reflux disease.

Sometimes benign or malignant changes cause hoarseness. For example, benign edema on the vocal folds (Reinke's edema), vocal cord polyps or cysts can affect the voice. Malignant throat cancer is less common.

Paralysis can also be responsible for hoarseness. For example, if the muscles of the larynx are partially or completely paralyzed due to nerve damage, the vocal folds can no longer vibrate properly. Possible causes include

  • Operations in the neck area (e.g. on the thyroid gland) or
  • an enlarged thyroid gland (such as a goiter).

In addition, injuries to the neck can lead to hoarseness - for example, from forceful effects on the larynx or from a ventilation tube inserted into the windpipe through the mouth or nose.

Other possible organic causes of hoarseness are:

  • hormonal changes (e.g. if you have an underactive thyroid or hormone treatment)
  • congenital malformations of the larynx (e.g. an underdeveloped larynx or vocal fold furrow)

Presbyphonia: voice changes with age

Sometimes hoarseness arises as a result of the natural aging process. Because, among other things, the vocal cord muscles lose their elasticity over the years. The voice becomes weaker and it takes more effort to speak than before.

Inorganic causes

Hoarseness can occur even without organic changes in the vocal apparatus.

If the voice remains absent, this is often due to an overload or improper strain on the voice - for example through singing, screaming or speaking for a long time. Accordingly, singers and people with typical speaking professions are often affected by hoarseness - such as:

  • Teacher
  • kindergarten teacher
  • Call center staff
  • Barkers
  • actor
  • doctors
  • Pastor

Hoarseness can be temporary, for example when someone has strained their voice for a short time at a rock concert. However, the voice can also be hoarse over a longer period of time. Such chronic hoarseness mainly affects people who regularly strain their voices heavily due to their work.

Constant overuse of the voice can cause thickening or nodules to form on the vocal cords. Then the hoarseness has secondary organic causes.

In addition, a hoarse voice can be an expression of psychological stress or illnesses. Typical psychological causes of hoarseness are:

Hoarseness can also be a symptom of a severe voice disorder called spasmodic dysphonia. When those affected use their voices, movements of the vocal folds and cramps in the larynx muscles that cannot be voluntarily influenced occur.

Even if nerves in the brain that play an important role in the speech process are damaged, hoarseness can occur. Possible causes for this are, for example:

Hoarseness: diagnosis

Medical help is not always necessary immediately in the case of hoarseness. In most cases, the symptom will go away on its own after a few days.

Be sure to get medical advice if you've been hoarse for more than three weeks. You should immediately go to a doctor's office with hoarseness if certain risk factors are present - for example:

To get to the bottom of the hoarseness, the doctor will first ask a few questions, for example:

  • How long has the voice been hoarse or gone?
  • Do you have to speak a lot in your job?
  • When does the hoarseness occur? Are you z. B. constantly hoarse or only at certain times of the day?
  • Do you have pain and / or difficulty swallowing?
  • Have you had any recent exposure to chemical irritants or smoke?
  • Do you smoke? Do you drink alcohol?
  • Have you had an operation in the neck area?

This is followed by a physical examination: for example, the doctor palpates the lymph nodes, examines the mouth and throat, or listens to the lungs. If there is suspicion that an infection is behind the hoarseness, a smear can be useful to determine the pathogen.

A larynxoscopy is mainly used if the hoarseness has been around for a long time. This examination is also important in the case of complaints that could possibly be related to a serious illness.

The specialist in ENT medicine looks at the larynx with the endoscope. In the meantime, a stroboscopy can be helpful: With its help, the rapid movements of the vocal folds can be made visible through a kind of slow-motion recording, thus recognizing disorders of the vocal cords.

Depending on the likely cause of the hoarseness, additional diagnostic tests may be useful - for example:

What to do with hoarseness

In the case of hoarseness, therapy is based on the cause of the disorder. Some examples:

If the hoarseness arose because you have to speak or sing a lot in your job, voice therapy / voice training can help. If, on the other hand, you have used your voice once, for example during a rock concert, it is sufficient to take it easy for a while.

If you have a hoarse voice because of vocal cord nodules, voice therapy is an option. You may be able to remove the nodules in a small operation.

If you have a husky and hoarse voice due to bacterial laryngitis, antibiotics are used.

If you have reflux disease, where acidic gastric juice irritates your larynx, your doctor may prescribe a proton pump inhibitor (such as pantoprazole) for you. The drug binds excess stomach acid.

If hoarseness is psychological, psychotherapy can be helpful.

If cancer of the larynx is behind the hoarseness, treatment consists of surgically removing the tumor and / or irradiating it.

What helps against hoarseness in the context of a cold?

If the voice is hoarse or gone because of a cold, no special medical treatment is usually necessary. The hoarseness will disappear after one to two weeks at the latest without you having to do anything specifically about it.

To relieve symptoms such as fever, runny nose or pain, you can temporarily take medication with active ingredients such as paracetamol or diclofenac and / or use a nasal spray.

Video: 5 tips for coughing and hoarseness


What you can do yourself

If you're hoarse or your voice is gone, there are a lot of things you can do by yourself:

  • Take care of your voice - that means: speak little and do not even whisper.
  • Try not to clear your throat as much as possible.
  • Drink a lot: Warm drinks such as tea are beneficial.
  • In any case, refrain from smoking and avoid smoky rooms.
  • Do not drink high-proof alcohol.
  • Temporarily avoid very hot and spicy meals.

Can home remedies help with hoarseness?

To what extent home remedies are helpful for hoarseness has not yet been scientifically clarified. Some consider warm milk with honey or steam baths with chamomile or brine salts to be suitable remedies for hoarseness. Some sweets (e.g. with primrose root or Icelandic moss) can be beneficial.

However, spicy cold drops - for example with menthol - are not recommended for hoarseness.

Online information from the Pschyrembel: www.pschyrembel.de (accessed on: September 18, 2020)

Online information from the German Society for Phoniatry and Pedaudiology (DGPP) e. V .: www.dgpp.de (access date: September 18, 2020)

Hahn, J.-M .: Checklist internal medicine. Thieme, Stuttgart 2018

Riedl, B., Peter, W .: Basic knowledge of general medicine. Springer, Heidelberg 2017

Angerstein, W .: Changes in voice and larynx in old age (presbyphonia and presbylarynx). Language - Voice - Hearing, Vol. 40, Issue 3, pp. 131-135 (September 2016)

Reiter, R., et al .: Hoarseness - Causes and Therapy. Deutsches Ärzteblatt Vol. 112, Issue 19, pp. 329-37 (8 May 2015)

Battegay, E. (Ed.). Siegenthaler's differential diagnosis. Thieme, Stuttgart 2013

Feldmann, H., Brusis, T .: The opinion of the ear, nose and throat doctor. Thieme, Stuttgart 2012

Arnold, W., Ganzer, U .: Checklist ear, nose and throat medicine. Thieme, Stuttgart 2011

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Last content check:18.09.2020
Last change: 18.09.2020