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Hoarseness - causes, diagnosis, therapy

What is hoarseness?

  • Hoarseness expresses a disorder of the voice and has to do with the condition of the vocal system and the larynx. Experts refer to voice disorders as Dysphonia. Hoarseness is the leading symptom of dysphonia.
  • The voice no longer sounds full and clear, it sounds rough, scratchy, thin, flat, grumpy or squeaky. So the sound of speech is changed.
  • Speaking is exhausting, and sometimes the voice fails completely.
  • The finely tuned interplay between breathing, vocal folds, nerves and muscles in the larynx is disturbed.
  • There are many causes of hoarseness. The majority are benign, but also include vocal cord paralysis and sometimes larynx cancer.
  • Most important therapy methods: voice therapy and interventions on the vocal cords (phonosurgery, voice-improving surgery).
  • Medicines, larynx surgeries, chemotherapy, and radiation therapy play a role in some specific causes, as do aids and substitute voices.

Seven tips for hoarseness

1.Room air is sufficiently humid hold, especially in the heating season.

2.Moisten the throat area: For example, you can inhale with salt water vapor. Sage lozenges or Icelandic moss lozenges often help people with colds and are often good for people who speak or sing a lot, subjectively. The saliva mobilized when sucking provides moisture. These herbal ingredients, as well as those contained in the pastilles, strengthen the resistance of the pharyngeal mucous membrane.

3.Drink enough fluids daily: It should be at least one and a half liters per day, with warmth half a liter more (applies to everyone without medical restrictions on fluid intake). To choose from: mineral water, warm fruit teas and herbal teas (e.g. made from sage), juice spritzer, no alcohol.

4.Do not smoke.

5. protect your voice, but no absolute calmness of the voice and not a permanent one either Clear throat or whisper (both strain the voice!). To get rid of phlegm, it is better to cough or swallow.

6. With hoarseness no decongestants such as using certain cold remedies; they dry out the mucous membranes.

7. Absolutely for ENT doctor should go:

-Anyone over three weeks is hoarse, even if you have a serious underlying disease, pain or swelling in the throat area, problems breathing or swallowing, fever.
-Anyone over four weekshoarse is: Have the larynx examined endoscopically. This also applies to people with hoarseness, the smoke and or drink alcohol regularly.

More info below: "What else can you do for your voice".

How hoarseness comes about

Sounds are created by the vibrations of the Vocal folds. These two ligaments covered with mucous membrane lie horizontally in the larynx, the upper part of the windpipe.

When swallowing, the larynx shields the airways. He keeps it open to breathe. This means that when we breathe in, the vocal folds or cords are dilated and relaxed so that air can flow in through the gap. If a sound is to be produced, they tense up and stand accordingly narrow.

The air flow that rises when you exhale presses against it, the vocal cords start to vibrate, the air vibrates between the larynx and the oral cavity. The pitch changes depending on how tense and therefore long (higher notes) or relaxed and short (lower notes) the vocal folds are.

The movements of the vocal folds regulate the internal and external muscles of the larynx; the volume depends on the pressure that the air creates when you exhale. This explains, among other things, why posture and breathing technique are so important for good speaking or singing.

Finally, the sounds are further shaped by the air in the throat, mouth and nasal cavities. The tongue and lips of the mouth create sounds, sounds, words and melodies from them.

The vocal folds in the larynx are sensitive

The harmonious play of the vocal folds is easy to get out of sync. Who hasn't screamed hoarsely before? At a boisterous party, a pop concert, a heated discussion. Singers and people who have to talk a lot and loudly, such as teachers, know how susceptible their voices are to overload.

If it is overused, the vocal cords can swell and no longer close properly. Speaking is painful and tedious.

Anyone who speaks against the hoarseness that then follows risks further damaging the mucous membrane. Nodules can form, which further impair the ability to vibrate.

A multitude of internal and external stimuli make you hoarse. Mental tension, cramped body muscles, wrong To breathe have a detrimental effect on the functions of the larynx. Nervousness makes the voice rough and shaky, dry air and smoking make the sound thin and scratchy.

But even if someone does not speak for a long time, it often takes a while for the voice to get going again.

Finally, a common cold can be a typical symptom of hoarseness. For example, if the larynx is inflamed by a viral infection, they swell Mucous membranes on the vocal folds. These can then no longer open or close as required. Breathy ("breathy"), rattling, hoarse sounds arise.

A number of internal and neurological disorders can affect the vocal apparatus. The list of harmless to serious diseases that affect the larynx and vocal cords is long.

Hoarse from job, living conditions, habits

Frequent speakers or singers can overuse their voices. Anyone who frequently stays in rooms with dry air at work, is exposed to toxins or who smokes and drinks too much alcohol is detrimental to their vocal health.

  • Overuse of the voice

People who overload their voices are very often hoarse. The voice quickly becomes dull and speaking becomes increasingly difficult. Often it burns or presses in the larynx, which is also increasingly covered with mucus. Teachers, call center staff, professional speakers and singers are often affected.

If someone speaks too much and too loudly for longer periods and often struggles against a noise level, he expends a lot of force. The vocal folds then hit each other violently.

Due to the strong stimulus, they redden, swell and can no longer vibrate as well. Those who breathe incorrectly and are cramped in the shoulder and neck area put additional strain on the vocal apparatus.

The hoarseness subsides when the vocal folds are given time to recover after a brief overload. Relaxation, correct breathing technique and posture are important, as is sufficient moisture.

That means, drink a lot of non-alcoholic drinks, do not smoke, pay attention to the correct humidity (see above and at the bottom). Above all, however, a good vocal technique helps frequent speakers and singers to avoid damage.

Anyone who ignores the hoarseness that occurs risks further damage. The voice remains thick and scratchy. The vocal cords can sag and no longer close properly.

It can also Nodules Form on the vocal folds (so-called singer's nodules). They also hinder the closure of the vocal folds. A Voice therapy then comes first (more on this below: "Voice therapy ..."). Microsurgical removal is less necessary as a second step in adults. In children, vocal cord nodules often recede spontaneously after the voice change during puberty.

Reports about the harmful effects of smoking are now piled high. The next victim of the blue haze is the vocal apparatus? Correct, there is nothing to be shaken about: Tobacco smoke with the poisons it contains irritates the sensitive vocal organ constantly.

Often one develops chronic laryngitis (see below: "Hoarseness with inflammation in the throat and larynx"). Many smokers are familiar with the typical morning cough attacks and the harsh sounds from a smoke-covered throat. Hoarseness is often involved.

In addition, tobacco smoke damages pathways such as nerves and blood vessels, which are also the basis of a functioning voice.

The so-called Reinke edema mostly affects smokers over 40. It corresponds to chronic inflammation and swelling below the vocal cord mucosa. Your voice sounds grumpy, deep and manly.

If successful smoking cessation and voice therapy do not improve the pitch of the voice, after a precise diagnosis and examination by the phoniatrist, an ear, nose and throat doctor who specializes in disorders of the voice, speech and language, a voice-improving procedure may help. It should remain when you quit smoking.

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Also exerts a harmful stimulus on the vocal cords alcohol out. Alcohol is a cell poison that is absorbed through the mucous membranes, sometimes in the mouth. Immediate consequences of too much alcohol, such as coordination and movement disorders, also affect language.

The mucous membranes can swell. Smoking and excessive alcohol consumption are also major risk factors for throat cancer (see section "Tumors in the larynx").

Liberating oneself from alcohol addiction is often more sustainable with withdrawal treatment and accompanying psychotherapeutic support.

  •  Pollutants, radiation exposure

Anyone who frequently smoke, exhaust fumes, particulate matter or Pollutants exposed, has to struggle repeatedly with persistent hoarseness and dry cough, depending on how intense the stress is.

The mucous membranes are irritated and react with swelling and redness. Serious injuries or burns can also occur. When dealing, for example, with industrial and car exhaust fumes or heavy metals such as chrome, lead or nickel, those affected should absolutely comply with the necessary safety and work regulations.

Hoarseness in puberty, menopause, in old age

Hormonal and developmental changes, for example during puberty or menopause, cause vocal changes that are often associated with hoarseness. Even with old age, the voice sometimes becomes fragile and weak.

Especially adolescent men have im Broken voice struggling with hoarseness. The larynx often grows faster during puberty, and vocal training does not follow suit.

The voice shifts between high childish and lower adult tones. Sometimes it sounds rough and scratchy, then again squeaky or weak and often overturns. Over time, most boys find their own proper adult tone.

In some cases, this voice development may either last an unusually long time or not fully complete. A falsified voice remains. Experts speak of Mutational disorders the voice. Psychological relationships can also be hidden behind this. Voice therapy (see below) and, if necessary, psychological support usually have a positive effect on the pitch of the voice.

  • Hormonal changes in women

During pregnancy or during menstruation alone, women experience that their voices sound hoarse and deep. The hormonal changes sometimes cause the mucous membrane on the vocal folds to thicken. Pregnant women sometimes have a lumpy or dry feeling in the throat, which is often mucous.

During the menopause, the female hormones estrogen and progesterone decrease, male hormones increase.

You can be responsible for the fact that the voice then sounds deeper and hoarser than before. Relaxation techniques and a healthy lifestyle with a lot of physical exercise not only support well-being in these years of upheaval, but also the pitch of the voice positively.

As you get older, the muscle fibers in the larynx lose their elasticity, especially if your voice is not exercising. The fine mucous coating of the vocal folds becomes more viscous. Overall, the vocal folds' ability to vibrate decreases. Singing with the right technique is also a good way to keep your voice fit.

In about a quarter of those over 65 years of age, the "voice of old age" (technical term: presbyphonia) is also associated with hoarseness.

In addition, there are a number of changes in the nerves and blood vessels as well as diseases that have an influence on voice formation. Rheumatic diseases can cause inflammation with thickening of the vocal folds (bamboo nodules).

The use of various medications, including those for high blood pressure, can also lead to hoarseness.

Hoarseness: when to see a doctor?

Holds a hoarseness longer than three weeks, those affected should consult a doctor in any case (see also above: "Seven tips for hoarseness", point 7); if the voice disorder is associated with pain, shortness of breath, difficulty swallowing and fever, immediately. The symptoms can be signs of a life-threatening bacterial inflammation and swelling of the epiglottis over the glottis, an epiglottitis.

In the event of an allergic shock or angioedema, a seizure-like swelling of the eyelids, lips and face, the glottis can also swell (edema means swelling). In this dangerous glottic edema, the voice changes first, but above all there is a risk of severe shortness of breath or suffocation (Emergency call: Tel. 112).

Otherwise, the family doctor may refer his patient to an ear, nose and throat doctor or a phoniatrist (specialist in phoniatrics, see above).

Further specialists can be a neurologist, a specialist in internal medicine (internist) or an allergist for allergic diseases, depending on the suspected diagnosis (see also below, "Diagnosing hoarseness").

Hoarseness - the most common causes of illness

Many factors and diseases can affect the voice. The main triggers of hoarseness are listed in the following sections.

This concerns both functional and organic disorders of voice training. Functional voice disorders result from frequent, loud, forceful speaking, often in people with speaking professions.

Organic voice disorders include any changes in the larynx that affect the voice. Vocal cord nodules, for example, can be the result of a functional voice disorder as an organic change.

Hoarseness in inflammation of the throat and larynx