Hoarseness: always worth a visit to the doctor

Written by: Mr Ravinder Singh Natt
Edited by: Nicholas Howley

If you have a hoarse voice, a quick trip to see an ENT doctor is always worth it, writes Mr Ravinder Natt. A hoarse voice is easy to investigate and you’ll get the results in minutes. Most of the time there’s nothing to worry about – but if the cause is something serious then an early diagnosis can make all the difference…

Hoarseness is a general term to describe a change in your voice. Patients often describe their voice as lower than normal, with a “gravelly” feel to it. It can also sound breathy or strained.

What causes hoarseness

There are a lot of misconceptions about what tends to cause hoarseness. The patients we see are often worried that hoarseness is a sign of throat or mouth cancer. Thankfully, this is highly uncommon – but it is important to rule it out nonetheless. As for smoking, this can cause a slight change in your voice but is not enough on its own to make your voice hoarse.

The most common causes of hoarseness are in factvocal cord strain, gastric reflux, and inflammation of the upper airways.

Vocal cord strain

Vocal cord problems are surprisingly common. They are mostly associated with professional singers, but any job that involves constant use of the voice – such as teaching, presenting, or sales – can result in vocal cord problems. Some of the most common issues are nodules, polyps or cysts which develop on the vocal cords and interfere with the quality of your voice.

Gastric reflux

Gastric reflux is a stomach problem that causes acid to move back up the oesophagus and into your throat. Hoarseness in the voice is caused by the stomach acid irritating the vocal folds in your throat. Gastric reflux is an extremely common problem – by some estimates it affects between 10% and 20% of the population in the Western world.

Upper airway inflammation

A number of infections can cause your upper airways to become inflamed, including the common cold and the flu. Environmental factors can also play a role – for example, we are becoming increasingly aware of effects of air pollution on the lungs, and the increasing incidence of asthma in urban areas. When the upper airways become inflamed, hoarseness is a common symptom.

Why it is worth getting your hoarse voice checked

Although hoarseness is very rarely caused by cancer, it is very important to get yourself checked and make sure – an early diagnosis can make all the difference.

Patients don’t need to worry about the examination. It simply involves a quick endoscopic examination which doesn’t even require sedation. The test takes a few minutes, and you will get your results immediately.

We will always do a chest X-ray if you have hoarseness. If we find something that we need to see in more detail, we might refer you for a CT scan.

How hoarseness is treated

Treatment for hoarseness depends on the underlying problem. If you have damaged your vocal cords through overuse we might recommend speech therapy, which is essentially physiotherapy for the voice box. Gastric reflux can often be treated with dietary changes and medication. Hoarseness caused by an upper airway infection is generally self-limiting, and there are a range of over-the-counter medications to help with the symptoms while you recover.

On the whole, there is a very good chance your voice will improve with treatment and with time. The main thing is to be smart – and get a hoarse voice investigated early.

By Mr Ravinder Singh Natt
Otolaryngology / ENT

Mr Ravinder Natt is a distinguished consultant ENT (ear, nose & throat) surgeon with considerable experience in treating a full range of general adult and paediatric ENT conditions through procedures and operations.

Mr Natt has a specialist interest in rhinology (the nose and sinuses), and facial aesthetic surgery, but sees both children and adults for all kinds of ear, nose and throat conditions.

After qualifying from Guy's & St Thomas' School of Medicine, he completed two prestigious fellowships in reconstructive facial aesthetic surgery and advanced rhinology and skull base surgery. Mr Natt has a strong background in education and currently serves as the Undergraduate Programme Lead for ENT/head and neck surgery at University College Medical School.

He regularly attends and delivers lectures at both conferences and courses, and often demonstrates surgical procedures to students and patients, staying up-to-date with the latest technology and treatments in his field.  

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