• Hoarseness is often temporary, but it can indicate severe underlying conditions like vocal cord cancer if it persists.

• Persistent hoarseness lasting more than two weeks or accompanied by red flag symptoms warrants a visit to an ENT specialist.

• Treatment can range from simple hydration and voice rest to advanced procedures like laser surgery.

BY DR NADHIRAH MOHD SHAKRI

It’ s a symptom, not a disease. Most of the time, it’ s temporary— but if it persists, your voice may be trying to tell you something more serious.

HOW DOES HOARSENESS HAPPEN?

Your voice begins with airflow from the lungs, which passes through the vocal cords in the larynx( voice box). When air blows through them, the vocal folds vibrate rapidly, producing sound.

This sound is then shaped into speech by the mouth, tongue, throat, and nose— the body’ s natural amplifiers and articulators. Anything that blocks airflow, irritates the vocal folds, or affects movement may alter vibration— resulting in hoarseness or voice changes.

COMMON CAUSES

Acute laryngitis – inflammation of the voice box lasting less than 2 weeks, usually from a viral infection or excessive voice use. Voice misuse – shouting, prolonged speaking or with poor voice technique. Common in high-vocal-demand professions such as singers, teachers, preachers, and call centre workers. Reflux disease( Laryngopharyngeal reflux) – when stomach content, such

Dr Nadhirah Mohd Shakri Lecturer & Otorhinolaryngology- Head and Neck Surgeon( ENT Specialist) Faculty of Medicine, Universiti Kebangsaan Malaysia Hospital Canselor Tuanku Muhriz Cheras Kuala Lumpur

NORMAL VOICE

BOX: V – vocal cord, P – post cricoid, leading towards the food passage( oesophagus), T – trachea, the breathing pipe leading to the lungs

THROAT CHECK: Flexible laryngoscopy is an office-based procedure in which a scope with a camera is inserted through the nose to assess the nose, throat, and voice box

as acid, pepsin, or bile, spills up to the throat, irritating the voice box. Benign lesions – Nodules(“ singer’ s nodules”), cysts, or polyps from chronic voice strain, respiratory papillomatosis caused by Human Papilloma Virus. Nerve-related problems – Vocal cord immobility following neck or thyroid surgery, viral infection, or sometimes even without a known cause. Chronic laryngitis – prolonged inflammation or irritation of the voice box, often from smoking or exposure to pollutants. Laryngeal cancer – The most serious, but curable when detected early.

SEEING A DOCTOR

Most hoarseness resolves within two weeks.

But if your voice hasn’ t returned to normal by then— especially if you notice these red

VOCAL STRAIN: Vocal polyp( reddish smooth surfaced lesion) on the left vocal cord. Vocal polyps typically occur due to misuse or overuse of the voice flags— it’ s time to see an ENT specialist: Difficulty breathing or swallowing A neck lump Coughing up blood Unexplained weight loss History of smoking or heavy alcohol use Previous neck or thyroid surgery

A hoarse voice that lasts more than two weeks needs to be checked. Persistent hoarseness may be the earliest sign of vocal cord cancer, which can be cured with early treatment.

EVALUATION

Your ENT doctor will start with a detailed history and examine your voice box using a flexible laryngoscope— a tiny camera passed gently through the nose.

This helps assess: Close examination of the voice box to look for any lesions. Assessment of vocal cord mobility. Identification of signs of acid reflux or irritation.

If needed, your doctor may also perform stroboscopy, a special light system that allows visualisation of vocal cord vibrations in slow motion.

Other recommended tests, such as voice analysis, scans, or biopsy, may follow depending on what’ s found.

TREATMENT

Treatment depends on the cause, but common treatments include: Voice rest and hydration for acute laryngitis Voice therapy with a speech therapist for misuse or nodules Reflux Management through lifestyle modification and medication Smoking cessation and avoidance of irritants Microlaryngoscopic surgery for cysts or polyps Injection laryngoplasty or thyroplasty for vocal cord immobility Laser surgery or radiotherapy for early laryngeal cancer

Surgery plays an important role in both diagnosis and treatment: Diagnostic- To obtain tissue for biopsy if cancer is suspected. Therapeutic- To remove vocal cord lesions such as cysts or polyps. Emergency- To secure the airway if large lesions obstruct breathing.

Can You Prevent Hoarseness?

✅ Stay well hydrated.

✅ Avoid shouting or whispering for long periods. Don’ t smoke.

✅ Avoid spicy and oily food. Avoid late-night snacks.

✅ Warm up your voice before prolonged speaking.

✅ See an ENT early for persistent hoarseness.

FINAL WORD

Your voice is the window to your life. It is part of who you are and reflects your health – whether you are a teacher, a singer, a preacher, or someone who enjoys conversations.

Early examination can save your voice— and sometimes, your life.- The HEALTH