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Hoarseness

Definition

Hoarseness is a condition resulting in a rough or harsh sound to the voice.

What is going on in the body?

Hoarseness may be caused by many things. Hoarseness may be acute (of short duration) or chronic (of long duration).
In evaluating hoarseness, the healthcare professional will want to know the answers to these questions:
  • How long has the hoarseness been present?
  • What was happening before the hoarseness started? Were there any other symptoms?
  • Has the person been over-using or straining the voice?
  • Has the person been experiencing shortness of breath, sore throat, dry mouth, cough, or difficulty swallowing dry food?
  • Has the person been near or in a fire within the past 48 hours?
  • Has the person tried anything at home to make the hoarseness better?

Risks

What are the causes and risks of the condition?

Causes of hoarseness vary but may include:
  • upper respiratory infection, such as a sinus infection
  • allergies
  • gastroesophageal reflux disease. If a person has reflux, juices from the stomach may go up the esophagus, or food pipe. The gastric juice can irritate the throat, causing hoarseness along with a sensation of a lump in the throat.
  • hypothyroidism, a condition in which there is too little thyroid hormone circulating in the bloodstream
  • injury caused by inhaling smoke
  • laryngeal cancer, or cancer of the vocal cords
  • laryngitis, or inflammation of the vocal cords
  • rheumatoid arthritis, a condition in which the joints are painful and swollen
  • Sjögren syndrome, which is a disorder producing hoarseness, dry eyes, and dry mouth
  • thoracic aortic aneurysm, which is an abnormal enlargement of a blood vessel
  • trauma or injury to the windpipe
  • paralysis of the vocal cords
  • presence of nodules on the vocal cords
  • medical treatments such as surgery in the area of the vocal cords
  • childhood infections such as croup
  • smoking or alcohol consumption

Prevention

What can be done to prevent the condition?

Avoiding smoking and exposure to smoke will decrease risk of hoarseness. Avoiding exposure to others with infections may also reduce the risk of hoarseness. Certain conditions and diseases that cause hoarseness are not preventable. If the person is using the vocal cords frequently, such as with singing, resting the voice between songs may reduce the risk of hoarseness. Seeking treatment for the underlying cause of the hoarseness may decrease the risk of hoarseness.

Diagnosed

How is the condition diagnosed?

In evaluating hoarseness, the healthcare professional usually will take a complete medical history. Any symptoms associated with the hoarseness will also be discussed. The person may be asked if there is a history of other illnesses or conditions, such as cancer, arthritis, or aneurysm.
On physical exam, the mouth and throat will be examined for redness, swelling, or drainage of pus. The neck will be felt for swollen glands, lymph nodes, thyroid enlargement, or other lumps in the neck. The healthcare professional may ask the person to stick out his or her tongue. If this is extremely difficult, there may be paralysis of one of the cranial nerves.
The eyes may be examined for ulcers or other abnormalities. The neck and chest may be examined for enlarged veins possibly indicating an thoracic aortic aneurysm. Vital signs, including pulse, rate of breathing, temperature, and blood pressure will also be monitored to evaluate for infection.
A laryngoscopy may also be necessary. This test involves putting a special tube with a down a person's throat. This allows the healthcare professional to see the throat and vocal cords to determine if there are problems. Blood tests and sputum cultures also may be ordered to identify infections.

Long Term Effects

What are the long-term effects of the condition?

Long-term effects depend on the cause of the hoarseness. If the hoarseness is caused by an upper respiratory infection or overuse of the voice, hoarseness may improve with rest, without any further effects. If the hoarseness is caused by other conditions such as cancer, long-term effects could result in permanent hoarseness or even death.

Other Risks

What are the risks to others?

The risk of spreading hoarseness to others will depend on the cause. If the hoarseness is the result of an infection, it may be spread to others. If it is caused from trauma, disease to the larynx, or cancer, it is not contagious.

Treatments

What are the treatments for the condition?

Treatment for hoarseness will depend on the cause. Upper respiratory infections may be treated with humidifiers, drinking warm fluids, bed rest, and medications. A person may be given antibiotics or anti-inflammatory medications. Medications to treat the underlying cause of the hoarseness may also be recommended. Resting the voice box by avoiding talking may also help the hoarseness. Avoiding smoking and alcohol may decrease hoarseness. In certain situations, surgery may be necessary to remove tumors or to take a sample of a tumor on or near the vocal cords to evaluate it.

Side Effects

What are the side effects of the treatments?

Home care, bed rest, warm fluids, and humidifiers should not cause side effects. Antibiotics may cause stomach upset, allergic reaction, or other side effects. Surgery can be complicated by bleeding, infection, or an allergic reaction to the anesthetic.

After Treatment

What happens after treatment for the condition?

After treatment, conditions will depend on the cause of the hoarseness. If an upper respiratory infection was the cause of the hoarseness, there may be no need for further treatment. If a chronic disease or cancer is the cause of the hoarseness, treatment could last a lifetime, or the course of treatment may change over time.

Monitor

How is the condition monitored?

Any new or worsening symptoms should be reported to the healthcare professional.

Sources

Professional Guide to Signs and Symptoms, Springhouse, 1997.

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