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HOARSENESS

Hoarseness is having difficulty producing sound when trying to speak, or a change in the pitch or quality of the voice. The voice may sound weak, very breathy, scratchy, or husky.

Causes:
1.Acute Laryngitis: The most common cause is acute laryngitis-swelling of the vocal folds that occurs during a common cold, upper respiratory tract viral infection, or from voice strain. Serious injury to the vocal folds can result from strenuous voice use during an episode of acute laryngitis.
2.Voice Misuse:

  • Speaking in noisy situations
  • Excessive use
  • Telephone use with the handset cradled to the shoulder
  • Using inappropriate pitch (too high or too low) when speaking
  • Not using amplification when public speaking
3.Benign Vocal Cord Lesions: Prolonged hoarseness can occur when you use your voice too much, or too loudly for extended periods of time. These habits can lead to nodules, polyps, and cysts. Vocal nodules (singers' nodes) are callus-like growths of the vocal folds. Vocal fold polyps and cysts also occur in those who misuse their voice, but can also occur in those who do not.
4.Vocal Hemorrhage: If you experience a sudden loss of voice following a yell or other strenuous vocal use, you may have developed a vocal fold hemorrhage. Vocal fold hemorrhage occurs when one of the blood vessels on the surface of the vocal folds ruptures and the soft tissues fill with blood. It is considered a vocal emergency and should be treated with absolute voice rest and examination by an otolaryngologist (ear, nose, and throat doctor).
5.Gastroesophageal Reflux (GERD): A possible cause of hoarseness is gastro-esophageal reflux, when stomach acid comes up the swallowing tube (esophagus) and irritates the vocal folds. Other typical symptoms of GERD include heartburn and regurgitation. Usually, the voice is worse in the morning and improves during the day. These people may have a sensation of a lump or mucus in their throat and have an excessive desire to clear it.
6.Laryngopharyngeal Reflux (LPRD): If the reflux makes it all the way up through the upper sphincter and into the back of the throat, it is called LPRD rather than GERD. The structures in the throat (pharynx, larynx, and lungs) are much more sensitive to stomach acid and digestive enzymes, so smaller amounts of the reflux into this area can result in more damage.  Many patients with LPRD do not have hearburn or other classic symptoms of GERD.
7.Smoking: Smoking is another cause of hoarseness. Because smoking is the major cause of throat cancer, if smokers become hoarse, they should see an otolaryngologist.
8.Neurological Diseases or Disorders: Hoarseness can also appear in those who have neurological diseases such as Parkinson's or a stroke, or may be a symptom of spasmodic dysphonia, a rare neurological disorder that usually affects only the voice, but sometimes affects breathing. A paralyzed vocal fold may be the cause of a weak, breathy voice. If the hoarseness persists for more than three months and other causes have been ruled out, a neurologist may be helpful for diagnosis.
9.Other Causes: These include allergies, thyroid problems, trauma to the voice box, and, occasionally, menstruation. Very serious conditions such as laryngeal cancer can also cause hoarseness.

Symptoms:
Hoarseness typically gives the voice a raspy and harsh quality, though it may also cause a change in the pitch or volume of the voice. The rapidity of onset and any associated symptoms will depend on the underlying cause leading to hoarseness.

Diagnosis:
Otolaryngologists(ENT) will obtain a thorough history of a patient's hoarseness and general health. They will then evaluate the voice and do a complete ear, nose, and throat exam. This includes examination of the vocal folds by laryngoscopy.  Laryngoscopy may be suggested by the otolaryngologist at any time during an evaluation for hoarseness, but if it persists beyond three weeks it should be evaluated and that evaluation should occur within a maximum of 3 months. The evaluation should be immediate if there is concern about a serious underlying cause is suspected.
Doctors usually look at the vocal folds either with a mirror placed in the back of the throat, or with a very small, lighted flexible tube (fiberoptic scope) that is passed through the nose to view the vocal folds. Videotaping or stroboscopy (slow-motion assessment) may also help with the analysis. These procedures are well tolerated by most patients. In some cases, special tests designed to evaluate the voice may be recommended. These measure voice irregularities, how the voice sounds, airflow, and other characteristics that are helpful in diagnosing and guiding treatment.

Investigation:
1.Complete Blood Examination.
2.Laryngoscopy
3.Throat culture.
4.X- Ray of neck.
5.CT scan.

Treatment:
The treatment of hoarseness depends on the cause. The infection in the throat can be treated conservatively. Most hoarseness can be treated by simply resting the voice or modifying how it is used. Smoking cessation is suggested for those individuals that smoke.
Homoeopathy-Homeopathic approach towards hoarseness is more totalistic and holistic. Rather than considering as a local problem, they are considered to be an affection of the constitution. Moreover, allergy (which lies at the root of this problem) is a constitutional problem and calls for constitutional approach for its management. Homeopathic treatment is based on same constitutional approach for management of any disease. Not only does Homeopathy help in resolving the problem of hoarseness but it also helps in preventing the recurrence.

Prevention:
Hoarseness can be prevented in some instances, for example:
  • Avoid situations that require excessive strenuous voice use, and if a person needs to project their voice, use a microphone if possible.
  • Voice therapists or singing teachers may be helpful in certain cases to assist individuals with vocal training and voice modification.
  • Smoking cessation can prevent hoarseness or the development of cancer of the larynx.
  • Individuals with hoarseness caused by gastroesophageal reflux (GERD) can benefit from medications and dietary modification.
  • Avoiding of dehydrating things in diet like alcohol, caffeine etc.
  • Plenty of water must be drunk.
  • Spicy food should be avoided.

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