Two bands of muscles constitute the vocal cords. They vibrate to create sound arising from the larynx. Hoarseness can arise from various etiologies. Excessive voice abuse such as talking too much, screaming, or repeated throat clearing can create irritant laryngitis with thickening along the edges of the true vocal cords (callouses of the vocal fold). These may occur on both sides of the vocal cords facing each other and leading to poor approximation of the free edges. The condition may progress to a nodule or polyp. Symptoms of vocal cord lesions include vocal fatigue, low-pitch gravely voice, breathy voice, inability to sing high notes, rough voice quality, frequent throat clearing, and voice breaks. Treatment usually constitutes speech therapy and video stroboscopy. Further options include removal of the nodule or polyp under general anesthesia if there is no significant improvement with medical treatment. Other causes of hoarseness include an upper respiratory tract infection with irritant laryngitis. Reflux can also irritate the larynx and contribute to hoarseness. Sometimes a tumor may develop over the vocal cords especially in smokers. Paralysis of the vocal cord can occur following and upper respiratory tract infection, surgery, trauma, or cancer within the neck or chest.
If hoarseness persists for more than 2 or 3 weeks, especially in smokers, it is critical to have the larynx checked by an ear, nose, and throat specialist, especially to rule out any serious anomaly. The otolaryngologist will examine the vocal cords and often use a scope or strobe light to assess the vocal fold vibration and movement. Treatment is based on the specific etiology causing voice disorder. Most of the conditions can be successfully treated if identified and diagnosed early.