Hoarseness

WHEN TO SEE YOUR DOCTOR

* Your hoarseness persists longer than a week.

* You are hoarse even though you have not had a cold, an allergy problem or a recent injury to your voice.

* You also have a lump or bump in your neck, persistent pain while talking or a greenish discharge from your nose.

What Your Symptom Is Telling You

Your vocal cords—two small strips of muscle behind your Adam's apple—move apart as you breathe and vibrate back and forth as you speak. When your voice is hoarse, it means something is keeping the vocal cords from coming fully together or interfering with the way they vibrate.

That something is usually swelling—from hours of happy howling at your son's football game (he won but you lost your voice), talking over loud background noise, yelling at your kids or even singing out of your natural range.

People who use (or abuse) their voices a great deal can develop tiny nodules on their vocal cords that produce hoarseness. These nodules are so common that doctors often name the condition after the professionals they treat. Singers', speakers', ministers' and teachers' nodules have been joined by one doctor's favorite— aerobic dance instructors' nodules. And in children, they're appropriately named screamers' nodules.

Of course, abusing or simply overusing your vocal cords is not the only thing that can cause hoarseness. A sinus infection or an upper respiratory infection such as a cold may swell the vocal cords, causing common laryngitis. And any condition that causes coughing or repeated throat clearing can also lead to hoarseness.

Another common cause of hoarseness is nighttime acid reflux—excess stomach acid that seeps up the esophagus into your throat while you sleep. What's tricky about this type of reflux is that you may not know you have it. One clue is unusually pungent morning breath. So if you have unexplained hoarseness and very bad morning breath, nighttime reflux may be the problem.

Allergies can be an indirect cause of hoarseness, since they cause the coughing, mouth breathing and postnasal drip that can inflame vocal cords. And substances that you may not be allergic to, like cigarette smoke and chemical fumes, can also irritate the vocal cords and cause hoarseness.

And all that cigarette smoke can cause hoarseness another way: By producing a tumor or growth on the vocal cords, a problem that hits smokers more than anyone else.

And no matter what the cause of your hoarseness, dry air makes it worse.

Symptom Relief

You don't have to be banished from the choir forever. There are many ways to treat hoarseness and get your instrument back in tune.

Rest your voice. Total silence is the most healing gift you can give your worn-out voice, says Howard Levine, M.D., director of the Mount Sinai Nasal Sinus Center in Cleveland. At the least, avoid the extremes—whispering and shouting. "Whispering puts tremendous stress on the vocal cords," Dr. Levine says. "If you must speak, you're better off using a soft voice."

Humidify, inside and out. "Inhaling the steam from a good old hot shower is one of the best treatments," says Glenn Bunting, a senior speech pathologist at the Massachusetts Eye and Ear Infirmary in Boston. Or try a steam inhaler. "It's like getting a facial," he says. You also might consider using a humidifier in your bedroom to offset the damage from dry indoor heat, he adds.

You need to get enough water inside your body, too. He suggests this guideline for healthy water intake: Increase your water consumption until your urine is clear. If you're taking vitamins like beta-carotene or medications that change the color of your urine, then simply consume 10 to 12 eight-ounce glasses of water daily.

Invite a chicken to lunch. If your hoarseness is from a cold, try chicken soup. "There's a good scientific basis for chicken soup," says Dr. Levine. The heat creates humidity, and the garlic is a good mucus thinner. If chicken soup isn't your favorite dish, he suggests taking a garlic supplement. Follow the manufacturer's suggestions for the recommended amount.

Thin secretions. Robitussin syrup is good for thinning out mucus, says Dr. Levine. But avoid antihistamines, which have a drying effect. A decongestant can also help reduce the flow of mucus, he says, but if you have a heart condition, check with your doctor before taking them. Certain oral decongestants may increase blood pressure.

Avoid aspirin. If your cold has produced a lot of inflammation, aspirin can cause more bruising of the vocal cords, says Dr. Levine, which can make your hoarseness worse. Choose a nonaspirin pain reliever instead.

Control your cough. Use a cough suppressant and expectorant to prevent coughing from further damaging your vocal cords, says C. Thomas Yarington, M.D., clinical professor of otolaryngology at the University of Washington in Seattle.

Don't gargle. Contrary to popular belief, gargling with mouthwash actually makes hoarseness worse, says David Alessi, M.D., an otolaryngologist in Los Angeles. Most mouthwashes contain alcohol, which irritates mucous membranes and dehydrates vocal cords. The gargled liquid doesn't actually get anywhere near the vocal cords, and the action of gargling itself is harmful. It will bang your vocal cords together and increase swelling.

Skip that drink. The alcohol in your cocktail has the same drying effect as the alcohol in a mouthwash, Dr. Alessi adds. If you're hoarse, soothe your throat with a nonalcoholic beverage instead.

Pass on the caffeine. "Stay away from caffeine—in coffee, sodas or chocolate," says Bunting. Caffeine is a drying agent, which won't help those inflamed vocal cords.

When You Need Medical Help

If vocal nodules are severe, or if a growth is discovered, your doctor can help.

Ask for voice therapy. If your vocal nodules don't clear up with voice rest and hoarseness-prevention techniques, your doctor may refer you to a speech pathologist for retraining your voice, says Dr. Levine. Surgery may be considered for severe cases.

Treat a tumor. If your doctor suspects a tumor is causing your hoarseness, don't let fear get in the way of help, says Dr. Levine. Most vocal cord tumors are small, and if they're found in an early stage, they can usually be cured while preserving your voice.

Preventing Future Problems

Once you've cleared up your hoarseness, here's how to keep that frog on his lily pad.

Warm up. Anyone who uses their voice a great deal is a vocal athlete, says Bonnie Raphael, Ph.D., a vocal coach for the American Repertory Theatre in Cambridge, Massachusetts. And just like any other athlete, they need a warm-up. Try this one before your next speech or concert practice.

Gently stretch your neck muscles by moving your head around slowly while breathing easily and allowing your jaw to hang loosely. Roll your shoulders in a number of different directions, then shake them loosely. Sip some water. Move your tongue around a little both inside your mouth and out. Yawn a few times and hum a bit of a song while feeling the sound vibrations on your gently closed lips. Do the same routine after you've used your voice, and you'll help forestall hoarseness.

Avoid irritants. Cigarette smoke, chemical fumes and wood dust all can produce hoarseness, says Dr. Alessi. Avoid exposure to cigarette smoke—your own and other people's. And wear a filter mask in the workshop to protect your throat and vocal cords from wood dust and fumes, he suggests.

Stop clearing your throat. Clearing your throat is a common habit that can be hard to eradicate, says Bunting. To avoid the hoarseness that can result, try swallowing instead, he suggests. Take a slow, extended swallow as though you are actually swallowing a bite of food. It will alleviate the sensation that something is in your throat, he says. (For more tips on eliminating throat clearing, see page 531.)

Let your voice travel lightly. If you travel in airplanes a lot, your voice will encounter two enemies—very dry air and the necessity of talking above the background noise of the engines. Bunting suggests adding a steamy shower to your pre-airport routine and drinking a lot of water during the flight.

Get up close and personal. If you have to communicate in a noisy environment, "try to do it close up and in the other person's range of listening," says Bunting. "The best position is face-to-face, so they can read your lips."