Hoarseness can be caused by a variety of conditions which may be local to the throat or general factors e.g. hypothyroidism. It may be related to your job, a social pursuit or social circumstances (e.g. having to shout at a relative or partner who is hearing impaired) or caused by a viral infection, smoking, a paralysed or weak vocal cord or several benign conditions of the vocal cords e.g. vocal cord ‘singer’s nodules, vocal cord polyps, vocal cord grannulomas, paillomas or laryngeal cysts.

Cancer of the voice box is not as common as some of the commoner cancers but it remains top on the list of most ENT surgeons to exclude when anyone presents with hoarseness. Smoking combined drinking excess alcohol are risk factors for developing cancer of the voice box.

Laryngopharyngeal reflux (LPR) is also a common cause of hoarseness. In LPR, acid from the stomach comes up in to the throat in spurts to constantly irritate the voice box. The voice box (particularly the vocal cords) is a very delicate structure that doesn’t like anything that irritates it, The vocal cords are fine looking structures that beat against one another in a very precise fashion to produce the human voice. Acid from the stomach causes inflammation and swelling of the vocal cords disturbing this precise approximation of the vocal cords. The whole voice box also becomes defensive from the irritation from acid leading to hoarseness or voice change.

Most people seeing an ENT surgeon with hoarseness will need to have a flexible laryngoscopy. This is an examination of the voice box and throat with a tiny flexible telescope with or without local anaesthesia. The examination is completed in less than two minutes and it gives a lot of information about the cause for many throat symptoms.


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