Dysphonia, colloquially known as hoarseness, is an alteration of the acoustic qualities of the voice that appears as a consequence of an inadequate use of the voice or organic disorder. There are two main groups of dysphonia:
- Of functional origin: in which no visible lesions are observed in the laryngeal exploration.
- Organic: lesions are observed in the laryngeal examination.
The group most frequently encountered by otolaryngologists in consultation is that of functional dysphonia. Dr. García Iriarte, an ENT specialist with more than 20 years of experience, points out that they are caused by situations of vocal overexertion maintained over time, together with emotional factors such as anxiety and incorrect vocal technique that favor the appearance of small organic lesions such as nodules or edemas that force the patient to make a greater vocal overexertion in order to be understood.
This causes an increase in chronic trauma and worsens the voice more and more, closing a vicious circle that in the end causes organic lesions of increasing size.
This type of dysphonia is also frequent in children, teachers, shopkeepers and singers who, due to technical defects maintained over time and together with situations of great emotional stress or phonatory overload due to vocal abuse, end up having repercussions in their voices.
The other large group of dysphonias are included in those of organic origin. These include acute laryngitis (inflammations generally of viral origin) that usually resolve in a few days. Chronic laryngitis is of greater interest, since it may be followed by laryngeal cancer.
Other causes, although less frequent, are those of neurological origin (affecting the mobility and tone of one or both vocal cords), traumatic (often after laryngeal intubation for general anesthesia, accidents, etc.), those caused by congenital malformations or disorders of vocal moulting in which the adolescent does not change his voice as usual and maintains a high-pitched voice despite his age.
What symptoms do these alterations produce?
Dysphonia can cause different alterations in the qualities of the voice, from a change in vocal timbre, pitch, intensity, speech rhythm, tremor, change in its resonance or vocal breaks or spasms.
Most commonly, dysphonia causes a less powerful voice, with an aggravated tone and vocal noise due to the turbulence caused by air leakage when phonating.
What is important to know is that any change in our voice that persists for more than 15 days should be explored by a specialist in otolaryngology because behind it there may be serious causes such as cancer. This occurs more frequently in patients with toxic habits such as tobacco and/or alcohol, mainly.
Treatment of dysphonia
The treatment will depend on the cause of the vocal alteration, so a proper diagnostic examination is essential.
In functional dysphonia the treatment will be mainly speech therapy, which helps to give the optimal tone to our vocal cords, to breathe before phonation, to correct habits harmful to the voice and usually has more than 90% success rate.
When there are already organic lesions such as a vocal polyp of considerable size or other lesions suspected of being cancer, endolaryngeal surgery with the aid of a microscope is the indicated treatment. Sometimes, after surgery we can refer the patient to a speech therapist to correct inadequate phonatory habits and avoid recurrence of the problem. Other endolaryngeal microsurgical techniques can also be performed in cases of cysts, sulcus and other organic lesions.
In the case of vocal cord paralysis, it is sometimes necessary to infiltrate some substance to improve vocal cord closure or external approaches if they are more severe.
There is another type of dysphonia called spasmodic, in which we infiltrate botulinum toxin to improve fluency and reduce blockages or spasms during phonation.
Can they be prevented?
In most cases yes. The way of speaking is learned from childhood and it is very common to find children with dysphonia because they have imitated their parents’ way of speaking. To prevent dysphonia of functional origin, it must be taken into account that the vocal cords have several layers inside them, that the most superficial layer must vibrate freely and that speaking at high volume, with great muscular tension and maintaining this over time, will surely cause a vocal problem that will gradually worsen if the causes are not modified in time.
In organic dysphonia, as in chronic laryngitis and laryngeal cancer, it is very important to avoid irritants, mainly tobacco, alcohol and gastroesophageal reflux that reaches the posterior laryngeal area, among others.
In summary, if we notice any voice alteration that does not disappear in about 15 days, a proper exploration and investigation of its causes should be performed in order to be able to adapt the appropriate treatment to solve the problem as soon as possible and avoid subsequent more aggressive therapies.