Hoarseness (Voice Disorders)

The human voice naturally changes from birth to death, but hoarseness or vocal disruption is not part of this normal process. There are various stages and treatment methods for hoarseness. In most cases caused by overuse of the voice, the first line of treatment is vocal rest. Other methods include voice therapy, vocal hygiene, medication, and vocal cord surgery.

LARYNGITIS

Sulcus vocalis is a congenital condition where the vocal cord surface lacks one or more of its normal layers, creating a groove. Symptoms include:

Weak voice
Voice cracking
Vocal fatigue
Thin or breathy voice

Diagnosis is made using stroboscopic examination. Mild cases can be treated with voice therapy. If ineffective, surgeryis required and must be followed by voice therapy to achieve optimal results.

TREATMENT OF HOARSENESS

Treatment methods vary depending on the cause. The most common treatment for hoarseness caused by overuse is vocal rest. Additional methods are applied in five stages:

1. VOCAL REST

Vocal rest means not using the voice for a certain period, allowing the vocal cords to heal from stress or trauma.

Typically recommended for 5–7 days
No speaking, whispering, throat clearing, or coughing
Helps damaged tissues begin healing
Prolonged rest may weaken the laryngeal muscles, so extended vocal rest is not ideal unless advised by a specialist

2. VOICE THERAPY

Voice therapy is one of the most effective treatments for hoarseness. It focuses on training patients to control laryngeal movement and vocal fold vibration through:

Breath support techniques
Resonance training
Glottal efficiency exercises

Voice therapy typically includes 6–8 sessions, each lasting 40–50 minutes with a speech therapist. Patients learn to use their voice safely and efficiently in daily life.

Some cases respond within 1–2 sessions, while others may require long-term therapy.

3. VOCAL HYGIENE

Also known as vocal health, vocal hygiene involves eliminating harmful behaviors and creating an optimal environment for voice use.

Important principles include:

Avoid throat clearing and excessive coughing
Avoid shouting or speaking loudly in noisy environments
Do not smoke
Stay hydrated
Humidify dry environments
Address hearing loss, if present
Reduce voice use if overused
Maintain a comfortable speaking tone
Follow these precautions especially during illness

4. MEDICATION

There are no specific medications to directly improve voice quality. The focus is on treating underlying conditions:

Antibiotics for infections
Antacids or PPIs for reflux
Painkillers if there is associated discomfort

Improvement in voice occurs only when the vocal fold tissue is healthy and correct vocal techniques are used.

5. VOCAL CORD SURGERY

Voice surgery (technically called microlaryngeal surgery) is performed under a microscope due to the delicate and layered structure of the vocal cords. The surgery involves removing problematic tissue while preserving healthy tissue.

Surgical options include:

Microsurgical removal of nodules, polyps, cysts
Microlaryngoscopic procedures under general anesthesia

Surgery is often followed by:

Medication
Voice therapy
Vocal hygiene protocols
Vocal rest

These support full recovery and help prevent recurrence.

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