Managing the Hoarse Voice
Hoarseness, or dysphonia, is what patients or other people hear as an abnormal voice quality. The formal definition adopted jointly by the American Academy of Otolaryngology-Head and Neck Surgery and the American Speech-Language-Hearing Association is: a disorder characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice‐related quality of life (QOL). It is essential to remember that dysphonia in and of itself can be devastating to social and professional interactions, and that it may be related to more dangerous disease processes either directly (e.g., glottic cancer) or indirectly (e.g., tumor invading the vagus or recurrent laryngeal nerves) affecting the function of the larynx.
How do we figure out why someone is hoarse?
At the University of Wisconsin, speech-language pathologists and otolaryngologists jointly assess patients with a presenting symptom of hoarseness using more and more sophisticated tools.
Mostly, it is the careful attention by a team of committed professionals that helps detect and parse out the nature of someone’s voice disorder.
Is dysphonia caused by one thing?
No. A wide variety of contributing factors including anatomic disease, reflux, allergy, medication side effects, psychosocial stress, trauma, autoimmune disease and others can separately or together make for dysphonia.
When should someone be referred for evaluation for dysphonia?
Although guidelines exist, formal data are lacking for a cutoff time point. Values range from 1 to 3 months. Clearly, a smoking and heavy alcohol history should prompt more rapid evaluation due to the risk of throat cancer. Also, if someone is professionally dependent on their voice (teacher, attorney, professional singer/performer) then more rapid attention is warranted. Associated symptoms of trouble swallowing, trouble breathing, weight loss and pain are also concerning.
With whom does our team collaborate?
Given the wide variety of causes of dysphonia, we have strong relationships with our colleagues in gastroenterology, pulmonology, rheumatology, neurology and psychology. This team approach assists in better understanding of the reasons why someone is hoarse and how to tailor treatment.
What treatment options are available?
A wide variety of treatment options are available including voice therapy, medications (adding or subtracting them), many office-based procedures and surgery. Voice therapy often is a few visits of an hour in duration at our clinic with a voice-focused speech-language pathologist and empowers patients to adopt better strategies for consistent, healthy, reliable voice production. Office-based procedures do not require sedation or an intravenous line and are completed in 30-minute time spans using only topical numbing for the throat. They include vocal fold injections for a wide variety of disorders, laser treatment, and detailed evaluation of the upper airway including the larynx, trachea, esophagus, and stomach. Office biopsies for cancer can often be performed the same day as the first visit, which speeds time to cancer treatment. Operations are mostly performed to allow patients to go home the same day or perhaps with an overnight stay. They are usually oriented around treating benign tumors such as papilloma, pre-cancer, or cancer, and are performed through the mouth with no neck incisions. Operations involving a neck incision often are performed to correct a paralyzed vocal fold or to remove cancer. When operations or office procedures are undertaken, patients are supported both before and after by the speech pathology team for counseling and rehabilitation of voice.
For more information
Learn more about dysphonia and other voice and swallowing disorders at the UW Health Voice and Swallow Clinics. Our physicians, speech pathologists and surgeons can quickly process referrals in adult and pediatric patients experiencing a wide range of voice, swallowing and airway issues. Our voice specialists enjoy an international reputation for excellence in providing highly specialized care for professional and amateur singers and actors, as well as other professional voice users such as teachers, broadcasters, salespeople, clergy and others. Visit the voice and swallowing appointments page for more information about patient appointments, or contact a clinic for questions and referrals.