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Hoarseness in adults

INTRODUCTION

"Hoarseness" is a term often used to describe any change in voice quality. This reflects a variety of complaints including vocal tremor, weakness, fatigue, altered pitch, breathiness, or strained voice quality.

Hoarseness that lasts for more than two weeks requires a complete otolaryngolic examination to rule out potentially serious causes such as malignancy. This is particularly a concern in patients with a history of tobacco or alcohol use who are at high risk for cancer of the head and neck.

The approach to the adult who presents with hoarseness will be reviewed here.

LARYNGEAL ANATOMY AND PHYSIOLOGY

The main functions of the larynx are:

  • Phonation, which refers to production of a vocal tone at the level of the vocal folds. The quality of the tone is modified by resonation through the upper airway and sinonasal tract and articulated into speech.
  • Airway patency during respiration, and airway protection from ingested material during swallowing. The normal swallow mechanism includes laryngeal elevation, posterior deflection of the epiglottis, and closure of the true and false vocal folds.
  • Valsalva, or generation of increased pressure against a tightly closed glottis. This enables functions such as cough, straining, throat clearing, and defecation.
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