When hoarseness lasts more than two weeks then the list of possible causes is greater. Understanding the cause of hoarseness begins with the history, possible triggers, exacerbating factors, your occupation or hobbies, underlying medical conditions. The sound of your voice can also offer clues to the disorder.
A visual inspection of your larynx and vocal cords is important to establishing a diagnosis. It can be performed with a light and small mirror, or with a thin flexible fiberoptic camera called flexible endoscope.
Treatment for hoarseness will depend on the cause of hoarseness. Repeated irritation from voice overuse, smoking, gastric reflux, or asthma inhalers when identified and then controlled, can help the voice. Hoarseness can be a manifestation of underlying diseases such as Parkinson’s, autoimmune disorders, neurogenic conditions. Hoarseness can be quite severe when neck surgery at the thyroid gland or cervical spine leads to injured laryngeal nerves. Aging tissues will also cause chronic hoarseness. Voice therapy with a speech language pathologist can treat hoarseness quite effectively. Alternatively targeted vocal cord procedures such as botulinum toxin injection, vocal cord augmentation, or microlaryngeal surgery can be offered in the proper setting.
Hoarseness lasting over two weeks can be a sign of cancer at the larynx or throat (pharynx). In the US laryngeal cancers account for 12,500 new cases annually, and less than 4000 cases annually for pharyngeal cancers. In contrast lung cancer accounts for 235,000 cases annually. Risk factors associated with developing cancers at the larynx and pharynx include smoking (current or former), vaping, advanced age, GERD, not vaccinated against HPV (human papilloma virus), strong family history of cancers. When detected early, cancers at these sites are successfully treated with surgery, radiation or combination of both modalities.
Acute hoarseness with identifiable triggers or circumstances should resolve with self-care such as voice rest and hydration. When the hoarseness persists beyond 2 weeks then it is important to see your doctor or schedule a consultation with an otolaryngologist.
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