Hoarseness of voice - Fractured voice

Voice is waves of sounds. It should not be treated just as sound, since it reflects one’s inner feelings / thoughts. Intelligent use of voice with variation in tone and pitch can influence anyone with deeper meanings. Harmony of tone can also give a clue to one’s emotional and health status.

Phonation quality usually differs from person to person, i.e., one’s voice may be soft or hard or hoarse. Changes in voice quality, volume, pitch may arise from throat ailments. Usually, to strengthen the argument or to be heard properly, people raise their voice. This raising in tone may stretch the larynx in an abnormal manner to produced injured voice - hoarseness.

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Hoarseness of voice is commonly treated as a voice problem. It is otherwise called laryngitis (inflammation of larynx). Creation of voice is made in the voice box/larynx. The networking of brain, tongue, lungs, pharynx, lips, nose and sinuses will give add-on features and figure out the expected sound (word) with good clarity. In case of hoarseness, the voice will be weak, scratchy, indistinct and difficult to produce. So one will take more effort to speak loudly which further makes the voice more and more rough and harsh. Hoarseness may sometime compel one to pause in speech.

Incidences – Overuse or misuse often brings complications. The vocal cord is in no way an exception. Everyone would have experienced hoarseness of voice in their lifetime due to cold/cough or after shouting in joy or sobbing in sorrow or dehydration. Hoarseness of voice occurs mostly in teachers, public speakers, callers and singers.

Causes – Hoarseness can occur due to various reasons. Usually, leak of air with improper closure of vocal cords is the fundamental cause of hoarseness. It may be because of functional or structural complaints. Commonly, it is associated with cold or upper respiratory infection. It can be acute or chronic depending upon the cause, intensity and nature of the complaint.

Psychological

• Anxiety, tension, stress can cause tremor all over the body and the vocal cord too to cause hoarseness of voice.

Physiological

• Puberty changes due to enlargement of larynx

• Misuse or overuse of the voice – speaking / singing / shouting / crying / doing mimicry loudly and continuously

• Stretching and damaging larynx with procedures of using endoscopy / bronchoscopy / ventillators

• Foreign body aspiration or hnhaling / taking irritants or allergens / administration of anaesthesia

• Habit of clearing throat often

• Overuse of alcohol / smoking / drugs

• Using cough lozenges often

• Dryness of throat with overuse or dehydration

Pathological

• Infection, inflammation and oedema due to viral or bacterial infection (laryngitis) -

• Cold / sore throat / TB / Diphtheria / STD infections.

• Tonsillitis / bronchitis with violent cough

• Allergies, sinusitis and post nasal drip

• Reflux oesophagitis (GERD)

• Growths / tumours – nodules / cysts / polyps in vocal cords and cancer in the throat

• Systemic illness – Hypothyrodism, Sjogrens’s syndrome, multiple sclerosis,

Symptoms – Presentation of complaints usually varies from person to person depending upon the intensity and nature of the complaint(s). It can be temporary or intermittent or continuous. Creaky voice most often ensues slowly to muffle the voice. Unless otherwise cared for, it will sustain hoarseness or mute the voice totally. Common symptoms are

• Tickling sensation in the throat

• Sensation of foreign material in the throat

• Voice struck in the throat / inability to produce expected clear sounds

• Hoarseness or change in voice with or without throat pain

• Pain / difficulty in swallowing

• Induction of cough

Diagnosis and investigations – Mostly just for hoarseness, no one will wish to go for investigations or treatment, since it commonly goes off very shortly. If it happens to persist, then detailed evaluation needs to be followed, i.e. with

• Oral examination for throat

• Blood tests (Tc, Dc, ESR, Hb, Absolute eosinophil count, Ig E, etc) to rule out infection and allergies

• X-ray, CT / MRI scan to rule out sinusitis, structural deformities in phonating organs, etc.

• Laryngoscopy to visualise vocal cords clearly to rule out nodules, cysts, polyps, throat cancer, etc.

• Throat swab / culture

• Hormonal evaluation of thyroid to rule out its dysfunctions

Prevention and management – In case of recurrent bout of hoarseness of voice, care should be taken to manage and to root out all the cause to prevent further bouts.

Do’s

• Voice rest at least for 1- 2 days (vocal fasting)

• Take lukewarm water often to maintain moisture of throat

• Salt water gurgling – 2 to 3 times / day

• Care for room humidity

Avoid

• Speaking / shouting / crying loudly and continuously

• Overusing voice while having cold or hoarseness

• Doing mimicry

• Clearing throat & spitting often

• Preservative added foods or known other triggers like ice creams, cool drinks, chocolates, fruits, etc.

• Inhaling chemical fumes / smoke / pollutants

• Tobacco chewing / smoking / alcohol / drugs

• Spicy, hot and acid foods to stay away from reflux oesophagitis

• Unnecessary drugs and nasal decongestants

General treatment – People used to ignore treatment / management since most of the time, hoarseness of voice will go off on its own (shortly or in course of time). Even though hoarseness of voice arises commonly as a medical problem, it can become a surgical complaint too. So, one need to be cautious and take care of hoarseness at the early stages itself. Negligence can sustain the complaints and extend the suffering period. In Allopathy, routine line of management is antibiotic course, pain killers (if pain is there) and treatment according to the associated diseases (allergies, bronchitis, cancer, thyroid problems, etc). In case of surgical complaints (tumour, nodule, etc), surgery will be advised.

Homeopathic approach – The scope of Homeopathy in treating hoarseness of voice is higher than any other system. Usually recurrent hoarseness of voice is very difficult to cure and antibiotics usually won’t have any beneficial effects on hoarseness, since it is often caused by virus or strain. Homeopathy has excellent remedies to clear hoarseness or laryngitis. Treating to the core, it can strengthen the vocal cord and larynx to resist infection and withstand strain. It can avoid surgery in most of the cases. To have good response, it is the first duty of the physician to educate the sufferer about the disease, need for vocal rest and its care. Also it is essential to educate them to have precaution against strain and respiratory infections (cold, cough, flu, etc.) with hygienic measures, since they all can bring flare-ups during treatment.

Precipitation of the episode (hoarseness) usually varies from person to person. It is often found to be related to a particular season / event / incident. Also, with respect to disease or complaints, patient’s feelings too differ. For some, there will be betterment on continuous use of voice (better in the evening than in the morning). For some, it may get worsened with usage (better in the morning and worst in the evening) and for some others, clearing the throat can give some relief. Homeopathy stands here with individualisation. In medicine selection, Homeopathy gives importance to the feelings / sensations, constitution of the patient, modalities (aggravating factors and ameliorating factors), to treat the nucleus of the suffering. With suitable medicines, Homeopathy can provide miraculous relief, shorten the suffering period and can resist further attacks by strengthening the immune system.

Homeopathic medicines commonly used in cases of voice hoarseness are Aconite, Ammon caust, Apis, Arg met, Arnica, Ars alb, Arum triphyllum, Belladonna, Borax, Bromium, Bryonia, Calc carb, Carbo veg, Causticum, Drosera, Ferrum phos, Ferrum picricum, Gelsemium, Hepa sulf, Hyosyamus, Iodium, Ipecac, Kali bich, Kali Iod, Lachesis, Lycopodium, Mag carb, Merc bin iod, Merc sol, Natrum mur, Nitric acid, Nux moschata, Nux vom, Phosphorus, Phytolacco, Plumbum met, Pulsatilla, Rhus tox, Rumex, Ruta, Sambucus, Sangunaria, Senega, Silicea, Spongia, Sulphur, Tarentula, Thuja, Valeriana, Vipera, Wyethia, Zinc met, etc, These medicines should be taken under the advice and diagnosis of a Qualified Homeopath.