This symptom, such as a decrease in sonority, muffled or hoarse voice in an adult, adolescent or child, appears with various respiratory diseases often enough. In such cases, it is said that the voice "disappeared" or "sat down".
However, this phobia (phonation) disorder, which has the R49 code for ICD-10, may be one of the signs and much more serious illnesses.
Causes of the hoarseness of voice in an adult
In clinical practice, the causes of hoarseness in adults are grouped into inflammatory (infectious and non-infectious), structural (neoplastic), systemic, neurological and specific, including iatrogenic. But this does not mean the impossibility of combining several reasons. Therefore, some clinicians - in the absence of a single classification - share the hoarseness of the voice on the types of etiology: if hoarseness is caused by inflammation of the larynx, it is considered organic (or true), in other cases it is classified as functional symptoms.
Otolaryngological statistics confirm that: hoarseness of the voice with laryngitis (acute viral inflammation of the laryngeal mucosa) is the most common case, since it is here that the vocal folds are located.
Overcooling and infection, leading to inflammation of the nasopharynx and upper respiratory tract, cause hoarseness of the voice in colds when an intense cough with a possible complication in the form of laryngitis, tracheitis or bronchitis begins. And the hoarseness of the voice with pharyngitis is a consequence of the inflammatory reaction of the pharyngeal mucosa to its viral or bacterial damage.
In 85% of cases, the pathogenesis of bronchial inflammation is caused by a viral infection, when a violent cough (especially long-lasting unproductive, throating sore) gives such a symptom as hoarseness of the voice in bronchitis.
Because of puffiness of the larynx and the region of the vocal cords, hoarseness in the angina - follicular or lacunar tonsillitis, as well as monocytic angina developing with infection by the Epstein-Barr virus, is possible. Practically all patients have a slight hoarseness in tracheitis, an acute or chronic inflammatory process located in the upper part of the respiratory neck and leading to swelling of the mucosa of its walls and a narrowing of the lumen.
But the hoarseness of the voice in pneumonia often occurs in cases of lung damage by the common type of obligate intracellular bacteria Chlamydia pneumoniae and the development of chlamydial pneumonia with sore throat, like with pharyngitis, and coughing, as with bronchitis.
Infectious inflammatory causes of dysphonia include fungal infections of the respiratory organs. So, the ubiquitous Candida albicans causes candidal pharyngitis - pharyngicosis and hoarseness. Although this yeast-like fungus usually does not create problems with the respiratory tract, but its activation is facilitated by the death of normal (competing) flora as a result of antibiotic treatment or with general immunodepression of the body.
In the case of any of the above-mentioned diseases, the pathogenesis of the disorder of voice formation is obvious: a violation of the formation of the glottis when the vocal cords are closed occurs due to the limitation of their mobility (in order for the sound to occur, the vocal folds should fluctuate as the exhaled air passes). And the mobility of the folds (consisting of the vocal cords and the vocal muscle) is sharply reduced as a result of inflammatory edema that occurs due to damage to the cells of the mucosal epithelium by viral or bacterial toxins and an increase in the volume of the interstitial fluid.
As non-infectious inflammatory causes of fainting, chemical or thermal burns of the throat, followed by partial necrosis of the mucous tissues, as well as hoarseness and allergy-with the inherent swelling of the tissues are secreted. In this case hoarseness of voice and cough with wheezing during inhalation are characteristic for allergic bronchitis, and hoarseness of the voice in bronchial asthma is aggravated by periodic difficulty of breathing until asphyxiation.
Sipot can be a consequence of irritation of ligaments and their lack of connectivity due to acid (gastroesophageal) reflux, for example, in hernia of the esophageal opening.
But the main non-infectious risk factor for dysphonia is present in smokers and those who, due to various reasons, constantly overload the vocal cords. This almost always gives the hoarseness of the voice in the mornings, and any attempt to force it can provoke aphonia (lack of sound). The key factor in the pathogenesis of this condition is chronic swelling of the ligaments - the so-called Reinke edema.
Structural, neurological and other causes of hoarseness
The soundness of the voice in an adult can be caused by structural neoplastic processes - pathological formations on the vocal folds in the form of benign granulomatous nodes (in sarcoidosis, laryngeal tuberculosis, secondary syphilis), cysts or polyps, and papillomas of the larynx when it is affected by papillomavirus (HPV).
According to doctors, when this symptom persists for three or more weeks in the absence of anatomical and neurological factors or obvious signs of inflammation of the respiratory system, one should suspect malignancy. The slowness of the voice in laryngeal cancer - like a sore throat, hoarse voice and earache, an increase in cervical lymph nodes - is on the list of symptoms of the laryngeal and pharyngeal carcinoma. And when localized in the throat of Kaposi's sarcoma, the disturbance of phonation is combined with a difficult swallowing.
Etiologically closely linked hoarseness and thyroid disease. With the increase and fibrosis of the thyroid gland, the pathogenesis of dysphonia is covered by mechanical pressure on the larynx located nearby, which interferes with the free vibration of the vocal cords. A hoarseness of the voice in hypothyroidism (a deficiency of the thyroxine hormone) and thyroiditis (inflammation of the thyroid gland) is the result of the edema of the vocal cords and their thickening. In addition, due to swelling of the mucous membrane lining the nasal cavity, hoarseness and nasal congestion are observed, and edema of the middle ear tissues reduces hearing in patients with hypothyroidism.
There may be hoarseness of the voice in the osteochondrosis of the cervical spine, and this is explained by the fact that as a result of protrusion of the intervertebral discs, the nerve endings are entrapped. In addition to hoarseness, their irritation and disruption of nerve impulses lead to such symptoms of cervical osteochondrosis as headache and dizziness, deterioration of coordination of movements, loss of hearing and vision.
The number of autoimmune diseases, one of the symptoms of which is a decrease in sonority, includes the same thyroiditis, as well as sarcodosis, Sjogren's syndrome and rheumatoid arthritis (affecting the neck joints in the larynx region).
There is an osseous voice with such neurological pathologies and neurodegenerative disorders as Parkinson's disease, multiple sclerosis, spinocerebellar atrophy, myasthenia gravis, stroke. The consequence of a malignant lung tumor, other mediastinal tumors or an aneurysm of the thoracic aorta may be partial paresis (paresis) of the overlying nerve, and in patients, in addition to hoarseness, there is a chronic cough, laryngospasm, sensation of a lump in the throat.
The numbness of voice on nervous soil is often called the spastic form of functional psychogenic dysphonia, and its pathogenesis is directly related to stress, which causes muscles to strain, including muscle fibers of the vocal folds. However, this is an exception.
A specific cause of hoarseness is the laryngeal chondoperichondritis - the inflammation of the tissues and membranes of its cartilages, caused by trauma or infection, to which the vocal folds are attached.
Iatrogenic risk factors include not only the hoarseness of the voice after chemotherapy, but also the trauma of the vocal folds (followed by the appearance of scars) during endotracheal intubation with general anesthesia; damage to the laryngeal nerves during surgery on the neck or chest; atrophic change in ligament tissues after prolonged use of inhalations with corticosteroids for asthma and chronic obstruction of the lungs.
It should be noted hoarseness of the voice during pregnancy: in the first trimester, vomiting due to toxicosis irritates the pharyngeal mucosa and larynx, and with the ligaments, the same can occur as with gastroesophageal reflux (see above). And in later terms, the cause of hoarseness lies in gestosis, leading to persistent swelling of the tissues.
By the way, calling risk factors for fade disorders, otolaryngologists, pulmonologists, endocrinologists and neurologists list all diseases and pathologies, the development or presence of which, with a greater or lesser probability, leads to the appearance of such a symptom as hoarseness.
So it remains to add well-known adverse factors: smoking, alcohol, the habit of boosting the voice (which is fraught with persistent hypertension of the muscular fibers of the ligaments), old age (with age the vocal folds lose elasticity), too dry and polluted air, respiratory conditions. And, of course, weak immunity, which reduces the resistance of the respiratory tract to infections.
Symptoms of the hoarseness of voice in an adult
The first signs of this type of dysphonia are a significant decrease in the strength of the sound of the voice, that is, a decrease in the frequency with which the ligaments vibrate, adjusting the size of the glottis. However, symptoms of hoarseness in the majority of cases are interrelated with other manifestations of diseases and in different versions are combined with comorbid symptoms.
Thus, hoarseness and coughing occur almost with all acute respiratory diseases (colds) and diseases of the upper and lower respiratory tract, as well as hoarseness of the voice, cough and temperature.
Dry barking cough and hoarseness are characteristic of laryngitis in an acute form and allergic bronchitis.
When palatine tonsils inflame and catarrhal tonsillitis develops, then the main symptoms are hyperemia or red throat, sore throat and hoarseness due to the swelling of the inflamed mucous tissues.
If you combine perspiration and sore throat even outside swallowing (and when swallowing the pain is felt in the ears), as well as hoarseness and temperature, it is most likely the case in the follicular sore throat. But to exclude the possibility of monocytic angina is also not worth it, because in its symptoms there are hyperthermia, and all the signs of a normal sore throat, intensified by a cough.
In addition, hoarseness of voice and pain in the ear can be signs not only of follicular or phlegmous sore throat, but also malignant formation in the throat. Important symptoms of a throat swelling are also the sensation of a foreign body in it, difficulty swallowing and halitosis (bad breath).
Sore throat and hoarseness are part of the symptoms of pharyngitis, tonsillitis, gastroesophageal reflux disease.
Often hoarseness without a sore throat indicates pathological formations in the larynx, for example, granulomas, cysts or papillomas.
In addition to colds with a runny nose and cough, hoarseness and congestion of the nose are often noted with allergies and hypothyroidism.
By the peculiarities of the manifestation of this symptom, it is easier for physicians to determine its etiology. If there is a sudden hoarseness, it can be caused by: acute laryngitis or bronchitis, bronchial asthma, tonsillitis, allergy, laryngeal cancer, metastasis of lung cancer.
At times, the arising and passing hoarseness is inherent in states that have triggers: gastroesophageal reflux, bronchial asthma, functional psychogenic dysphonia. A constant hoarse voice is one of the signs of diseases associated with structural changes in the vocal cords, tumors, thyroid problems and neurological pathologies.
Complications and consequences
Since the hoarseness of the voice is a symptom, the consequences and complications concern diseases with this violation.
With respiratory infections and respiratory diseases, a temporary loss of voice is possible - aphonia, which occurs after the treatment. And diseases that are not related to respiratory organs, except changes in voice timbre and inability to regulate its loudness, can lead to difficulty in swallowing, dyspnea with exercise, stridor (noisy breathing due to a decrease in the laryngeal lumen), chronic non-productive cough.
Diagnostics of the hoarseness of voice in an adult
In itself, the hoarseness of the voice does not require diagnosis: the sound of the patient's voice demonstrates the presence of a symptom. The doctor's task is to reveal the reason for this, for which you need a complete history (indicating the medications taken), in which there may be information important for the correct choice of survey methods.
In many cases, the otolaryngologist can listen to the patient's complaints and examine the oropharynx and throat with an ordinary frontal reflex. For more accurate diagnosis, instrumental diagnostics using larynx, lung and mediastinal organs is performed; laryngoscopy; laryngostroboscopy.
If you suspect a cause not related to ENT diseases, you may need electroglottography, electromyography of the larynx muscles; Ultrasound of the neck; CT of the cervical spine; MRI of the base of the skull and brain.
Blood tests are made: general, biochemical, on the level of thyroid hormones, etc.
In difficult situations it is possible to involve specialists of other specializations in determining the cause of hoarseness, and their consultations will fully provide differential diagnosis of the existing pathology.
Treatment of the hoarseness of voice in an adult
No single specialist will not treat osseous voices in an adult patient separately from the treatment of a disease or pathological condition that is accompanied by this symptom.
General recommendations: increase water intake (to avoid dryness in the throat) and for a while to be silent (even in a whisper do not go). And what medicines should be taken with loss of voice and hoarseness - the doctor determines, proceeding from the etiology of the disease. For the most part, physicians are limited to information on respiratory infections and respiratory diseases, in particular laryngitis (as a key cause of syphosis).
So, antibiotics with ospolosti voices are systemically applied only in the presence of bacterial infection. More in this article - Antibiotics for laryngitis
Widely used for the treatment of laryngitis, pharyngitis and angina local symptomatic means. For example, pills from the hoarseness of the voice of Septotelet, which are antiseptic tablets from pain in the throat (they should be absorbed in the mouth). And Lizobakt with hoarseness (also tablets for resorption) is used because of the antiseptic effect of its lysozyme component.
Lollipops are recommended from the hoarseness of the voice: Decatalene, Anti-Angin, Pharyngosept, etc. It also contains antiseptics and local anesthetics lollipops from sore throat.
Any recommended syrup from hoarse voice, in fact, is a cough syrup. And when coughing with phlegm, you should choose a remedy with extracts of licorice or althaea roots, and with dry syrups containing anise seed oil or ivy extract.
Sprays from the hoarseness of the voice with analgesic and antiseptic properties (Angilex, Cameton, Hexoral, etc.) are good, although they are also sprays from sore throat. But the antibacterial aerosol Bioparox in the hoarseness of the voice from the spring of 2016 is not produced and is prohibited for use.
Assign inhalation in the hoarseness of the voice - alkaline mineral water, sea salt solution, medicinal solutions Dekasan (effective for fungal lesions of the larynx and throat) or Miramistin. A greater therapeutic effect is given by
Inhalation in the hoarseness of the voice by a nebulizer - ultrasonic inhaler, which gives a finer dispersion of the drug solution, which is easier to penetrate into damaged tissues.
Suspension with corticosteroid budesonide Pulmicort from hoarseness of voice is not used: its purpose is the treatment of allergic cough and bronchial asthma, as well as the removal of acute laryngeal stenosis with laryngitis.
Homeopathy offers a homeostasis preparation from the hoarseness of the voice, which is taken internally - 5-7 times a day for two tablets; not recommended for pregnant women. There are also pellets for the oral administration of Bryonia (with a plant extract of the transgression white) and Phytolacca throat rinse (based on the American Platonicus plant).
Surgical treatment should be carried out in cases of pathological formations on the vocal cords, which are not amenable to drug therapy. Malignant tumors and Edneck edema are also removed by surgery.
Assignable physiotherapy treatment for voice disorders associated with inflammation of the respiratory tract consists in sessions of electrophoresis with drugs, phonophoresis and galvanic currents on the collar zone (in the absence of thyroid disease).
The main exercises for the vocal cords in the hoarseness of the voice are aimed at developing the right breathing - to reduce the strain of the muscles of the larynx.
How to cure the hoarseness of the voice at home?
Traditional alternative treatment is the treatment of inflammation of the larynx (pharyngitis) and throat (pharyngitis) by daily five-minute warm-moist inhalation with a solution of soda, table salt or sea salt (a teaspoon of 200 ml of water).
You can relieve cough, using herbal therapy in the form of ingested oregano, mother-and-stepmother, sweet clover, violet tri-color. They help to relieve the pain and inflammation of the throat of the rinse with broths of sage, chamomile, calendula, yarrow, plantain, nettle, eucalyptus leaf or laurel. It is also practiced to use a mixture of raw beetroot juice with water and apple cider vinegar to rinse the sore throat with a loss of voice. For more information, see - Treatment of laryngitis by alternative means
It is advised to take the gogol from the hoarse voice - a mixture of two egg yolks with a tablespoon of granulated sugar and a teaspoon of butter or fat cream. In a slightly warmer form, this is an ancient home remedy for sore throat. However, yolks are used in raw form, so there is a risk of intestinal infection - salmonellosis.
Among the proposed home remedies for dysphonia, you can often find very strange recipes. For example, make compresses around the neck from household soap with honey. Or there is a boiled peanut from the hoarse voice. Details of the latter means no one leads, however, according to the Journal of Agricultural and Food Chemistry, it is necessary to boil peanuts in uncooled water (right in the pod) and long enough for the nuclei to absorb the antioxidants contained in the peel. It should also be borne in mind that peanuts are a strong allergen.
Is it possible to prevent a symptom caused by so many causes? Perhaps, even the usual respiratory infections are quite problematic to warn. Nevertheless, do not smoke, breathe through the nose, drink enough water and consume vitamins - available to everyone ways to maintain the normal state of the mucous membranes of the respiratory tract.
Almost all problems with voice, including hoarseness of voice in an adult, are amenable to treatment. However, the prognosis worsens if this disorder is chronic, that is, it can be a symptom of cancer and numerous curable diseases.
Last update: 25.06.2018
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Medical expert editor
Portnov Alexey Alexandrovich
Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"
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