New Guidelines for Hoarseness

Just about all of us have experienced a hoarse voice at one time or another. Whether it’s from shouting too loud at a party or a bad cold, the hoarseness can run from a husky quality to downright annoying. Many times, being hoarse means not being able to work. If you depend on your voice to work, if you can’t talk, you can’t work. This results in lost income for you and likely for your employer.

Safety is another issue. When my children were young, I had a severe case of hoarseness and could barely be heard when there was no background noise, let alone in a crowd. I was shopping with my three young children when one of them got separated from us. I could see him ahead, but I couldn’t shout for him; no sound would come out of my mouth, other than a hoarse croak. That was very frightening and I remember it all these years later. I can still see where we were at the time,

Most of the time, a hoarse voice is benign, or harmless, but sometimes it’s the sign of something more serious, such as a growth or tumor. For this reason, people should be made aware that if their hoarseness, or dysphonia, lasts more than a short while, they should be checked by a doctor.

The American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNSF) is issuing the first set of guidelines to help doctors recognize hoarseness and how to manage it. The guidelines are to provide a framework for the physicians, giving them a tool that is consistent across the board.

Who Is Affected?

According to the AAO-HNSF,

“Hoarseness affects approximately 20 million people in the U.S. at any given time, and about one in three individuals will become hoarse at some point in their life,” said Richard M. Rosenfeld, MD, MPH, an author of the guideline and chair of the AAO-HNSF Guideline Development Task Force.

In children, it’s most common between the ages of 8 to 14 years. Fifty percent more women develop hoarseness than men and it’s not difficult to guess which people may have a higher rate of hoarseness than others: teachers, performers, telemarketers, aerobic instructors). Seniors also tend to develop a hoarse voice more frequently than younger adults.

I remember the first time I heard TV cook and personality Rachel Ray speak. As soon as I heard her voice, I commented that she should have her voice checked. Something didn’t sound right. The person I was speaking with blew off my comment, saying I was being overly critical, but it did turn out that Ms Ray did have a problem with her vocal cords.

Guidelines

Key features of the new guidelines include:

Most, but not all, hoarseness is the result of benign underlying or self-limiting factors; however, clinicians should consider the possibility of a serious underlying condition (growth or tumor of the larynx) or medication side effects as a cause.

Laryngoscopy is an office procedure to visualize the larynx (voice box and vocal cords) that should be performed if hoarseness persists or if the cause is uncertain.

Imaging studies, such as a CT or MRI scans, should not be obtained for a primary complaint of hoarseness prior to visualizing the larynx; laryngoscopy is the primary diagnostic modality and should be done first.

Anti-reflux medicines should not be prescribed for hoarseness unless there are (a) signs or symptoms of gastroesophageal reflex disease (GERD), such as heartburn or regurgitation, or (b) signs of inflammation of the larynx seen during laryngoscopy.

Steroids or antibiotics given by mouth are not recommended for hoarseness and should not be used routinely.

Voice therapy is a well-established intervention for hoarseness that can be performed at any age. Laryngoscopy should be performed prior to voice therapy and results communicated to the speech-language pathologist. Therapy for hoarseness usually includes one to two sessions per week for four to eight weeks.

Surgery is not the primary treatment for most hoarseness, but may be indicated for suspected cancer, other tumors or growths, abnormal movement of the vocal cords, or abnormal tone of the vocal cord muscles.

The risk of hoarseness may be reduced by preventive measures such as staying well-hydrated, avoiding irritants (especially tobacco smoke), voice training, and amplification during heavy voice use.

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