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.