Why are you hoarse? What should you do? There are a multitude of causes of hoarseness. Hoarseness is a common presentation to primary care physicians. The causes range from inflammatory processes to psychiatric disorders to more serious systemic, neurologic or cancerous reasons.
Medication can also cause hoarseness. The medications that may cause hoarseness are angiotensin-converting enzyme inhibitors (ACE) , antihistamines, diuretics, bisphosphonates, and inhaled corticosteroids.
How to evaluate hoarseness? Your physician should perform a targeted history and physical exam. Systemic conditions causing hoarseness should also be investigated. Initial treatment may be voices rest including no whispering (as this can worsen hoarseness) and treatment of the presumptive cause.
If you have reflux, the acid from the stomach can affect the vocal cords and cause hoarseness or a chronic cough from acid reflux (or lung cancer) can also cause hoarseness. Direct visualization with a nasolaryngoscope (a teeny tiny scope about 1/2 the size of your pinky finger) may be needed if hoarseness persists for 3 months if conservative management has not resolved the problem. An ear, nose, throat surgeon may do this in their office. If you have risk factors for oral cancer like tobacco use or heavy alcohol consumption or blood with coughing should opt for ENT referral after 2 weeks of symptoms.
Don’t I need imaging? Probably not. A CT scan is not done before visually examining the area with a nasolaryngoscope.
Voice therapy is effective for improving voice quality for patients with nonorganic difficulty with making sounds.
When do you need surgery? Surgery is needed for laryngeal or vocal fold dysplasia (or cancer!), airway obstruction, or benign pathology that is resistant to conservative treatment.