Hoarseness – causes and tips

A scratchy throat, pain when swallowing, and the voice is gone. Everyone knows these symptoms of hoarseness from personal experience, albeit due to different causes. But what exactly happens when our voice fails? What are the causes of hoarseness? And how do we treat hoarseness? We give tips against the complaints!

How does our voice work?

The larynx is responsible for the human voice. It is located on the front of the neck at the top of the trachea. In men, you can see it more or less clearly from the outside as the Adam’s apple. Inside the larynx, the two vocal folds are stretched.

The free inner edges of the vocal folds are called the vocal cords. Muscles, cartilage and joints can move the vocal folds to close the trachea except for a small gap. This narrowest part of the trachea is called the glottis or glottis.

When you breathe, the vocal folds are relaxed to allow air to flow freely in and out of the lungs. To produce a sound, we tense the vocal folds. The air coming out of the lungs causes the vocal cords to vibrate. Incidentally, the woodwind instruments bassoon and oboe also work according to a similar principle.

The more relaxed the vocal folds are, the slower they vibrate, and the pitch is lower. If they are tense, they vibrate faster, and the sound becomes higher. With the help of our throat, mouth, and nose, we now form words and sentences using this fundamental tone: we speak or sing, shout, or whisper.

 

What causes hoarseness?

There are many causes of hoarseness – but all of them mean that our vocal cords can no longer vibrate freely: We are hoarse, the voice is occupied, scratchy or fails.

hoarseness from infections

Hoarseness often occurs with colds or flu, along with a runny nose, cough, and sore throat, which are signs that the body is flooded with pathogens. The infection leads to swelling of the mucous membrane in the area of ​​the vocal cords so that the mobility of the vocal cords is restricted.

 

hoarseness from overwork

If the voice is permanently heavily strained by loud singing or speaking, for example, by singers or teachers, this can also lead to hoarseness because the vocal cords become slack over time.

Due to the constant overexertion, the mucous membrane on the vocal folds swells, and small nodules form, the so-called screaming or singing nodules. Sometimes, these nodules develop into Reinke’s oedema,  a swelling of the entire vocal folds. Polyps,  i.e. benign growths of the mucous membrane, can also develop from the vocal cord nodules.

hoarseness and tumour

Another possible cause of hoarseness can be a tumour in the larynx area. Benign changes include vocal cord nodules or vocal cord polyps, while malignant changes include laryngeal cancer or lip ligament carcinoma.

hoarseness after operations

During operations in the neck area, the larynx or the vagus nerve, which is responsible for the vocal cord function, can be injured. Special attention must also be paid to the larynx during intubation, such as inserting a tube into the trachea for ventilation.

 

Hoarseness from pseudo-croup

Pseudocroup is an inflammation of the larynx caused by viruses. It often occurs in younger children between one and five years of age. The mucous membrane swells directly below the vocal cords, causing the typical barking, rough cough and hoarseness.

Other causes of a hoarse voice

Smoking and chemical irritants can also irritate the mucous membrane in the larynx area, causing hoarseness, such as inhaling very cold or dry air. In addition, allergies, tuberculosis, diphtheria or Hashimoto’s thyroiditis can produce a hoarse voice.

Hoarseness: duration and symptoms

If the hoarseness lasts longer than two weeks and you experience severe pain or shortness of breath, you should see an ear, nose and throat doctor. For example, the doctor will ask you how long the hoarseness has lasted, other symptoms such as pain, fever or difficulty breathing, previous surgeries, or if you have been in contact with chemical irritants such as ammonia or hydrochloric acid.

 

Hoarseness: investigation and diagnosis

During the physical examination, he closely looks at your mouth and throat and feels the lymph nodes. If an infection is detected, he takes a smear and creates a culture. In this way, he can find out which pathogen caused the inflammation. A blood test can also help.

To examine the larynx in detail, the doctor performs a laryngeal endoscopy. Although this is uncomfortable for you, he can, especially if you then do some speech exercises, determine whether the vocal folds move in the same direction or whether their mobility is restricted. Further examinations such as ultrasound, X-rays, magnetic resonance imaging or computer tomography can then be carried out to rule out a tumour.

treat hoarseness

If the hoarseness is caused by a cold or a slight strain on the voice, there is a lot you can do yourself to bring the mucous membrane down again. Otherwise, the doctor will help you.

Hoarseness: what to do? Act yourself!

These tips help against hoarseness:

1. The most important thing is to protect the voice. Avoid speaking and whispering yourself, as this strains the vocal cords.
2. Hot drinks such as herbal teas and steam baths with chamomile, for example, relieve the scratchy feeling in the throat.
3. Add a handful of sage leaves to half a litre of boiling water and let the mixture steep for five minutes. After that, pour off the liquid, add a teaspoon of vinegar and a tablespoon of honey and gargle with this solution several times a day. After gargling, spit out the solution.
4. Sucking on throat drops stimulates saliva production and keeps the throat moist.
5. Dry room air, especially in winter, can be combated with an air humidifier or damp cloths.
6. Eat chives – it strengthens the vocal cords!
7. Both active and passive smoking (smoky pubs!) are taboo.
8. Put some quark on a damp linen cloth and tie the fabric around your neck. Wrap another linen cloth and then a wool cloth over it. Leave the curd wrap on overnight.

 

Hoarseness: Treatment by a doctor

If an infection occurs, the doctor may start treatment with antibiotics. Vocal cord nodules, Reinke’s oedema and polyps of the vocal cords always require surgery. A microsurgical intervention is usually sufficient, or a laser scalpel is used, and both methods are gentle and relatively bloodless. A malignant tumour requires extensive treatment with surgery, chemotherapy and radiation.