Wednesday, May 25, 2011


Sounding hoarse lately? This refers to any change of voice. It can be higher, lower, huskier, or even breathless. This blog is to help think about the potential causes.

Voice is the result of interaction between the nose, mouth and a structure called the larynx.

Hoarseness can be caused by a number of factors. If the hoarseness is persistent it needs to be evaluated especially if there are no acute symptoms of infection or if has gone longer than two weeks. Tobacco use and alcohol are two worrisome coexistent risks for head and neck cancer. Unexplained weight loss, painful swallowing, difficulty swallowing or one-sided throat pain or ear pain needs to be evaluated.

Other causes of hoarseness include: acute laryngitis, chronic laryngitis, benign growths, cancer, nerve dysfunction, neurologic disease, or stress.

Acute laryngitis is common and self-limited condition lasting less than three weeks. This is usually due to a virus although can be bacterial. Laryngitis can also be caused by strain such as yelling or coughing resulting in bleeding from microtrauma.

Chronic laryngitis is typically due to irritants over time. Things such as acid reflux, fumes, chemicals, chronic voice strain, chronic alcohol use, chronic sinusitis, chronic post-nasal drip, or tobacco smoke. Some symptoms include throat clearing, heartburn, change of voice, sore throat, feeling like a lump in throat, or choking sensation. Asthma type symptoms may also present this way.

Normal Vocal Chords

As noted, there are benign growths that can occur on the vocal cords. Smoking can cause swelling of the cords called Reinke's edema resulting a husky low-pitched voice( sounds like a man). Polyps and nodules can also occur due to smoking, acid reflux or chronic vocal cord irritation.

This is Reinke's edema. Note the soft swollen irregular appearances (this was due to reflux).

Some may know of singer's nodes. This can be true but usually occurs with screamers. This is more common in women and children.

Now to the possibility of cancer. The vast majority of cancer is squamous cell. Major risk factors include alcohol use and smoking. This is usually heavy alcohol use such as up to 4-5 drinks per day. There are many other potential causes that have not been fully proved such as viruses, genetics and diet.

Cancer. Note the irregular appearing mass from the right vocal cord.


Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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