Laryngology
Hoarseness
For hoarseness lasting more than 2 weeks: laryngeal examination, voice therapy, and microsurgery when indicated.
How long should hoarseness last before consulting a doctor?
Hoarseness lasting more than 2 weeks without improvement warrants laryngeal examination. The threshold is shorter in smokers, those over 50, and high-risk occupations (teachers, broadcasters, singers). Modern laryngology uses stroboscopic laryngoscopy as standard; most vocal pathology missed by static fiberoptic exam becomes visible on stroboscopy. Causes of hoarseness: vocal-cord nodule/polyp/cyst, laryngopharyngeal reflux, acute/chronic laryngitis, vocal-cord paralysis, pre-malignant lesion, and rarely laryngeal cancer. Treatment depends on cause: voice therapy, anti-reflux, microlaryngeal surgery.
Diagnostic algorithm
History: onset, pattern of voice change (worse in morning = LPR; worse with activity = nodule/polyp), accompanying symptoms (throat burning = LPR; chest cough = post-nasal drip). Risk factors: smoking, alcohol, professional voice use, recent viral infection, recent intubation.
Examination: indirect mirror laryngoscopy → fiberoptic nasopharyngolaryngoscopy → stroboscopy (vocal-cord vibration pattern). Suspicious lesions are biopsied under microlaryngoscopy. Acoustic analysis (jitter, shimmer, HNR) is used for quantitative follow-up.
Treatment options
Vocal-cord nodule: first voice therapy (8–12 weeks) — vocal hygiene, exercises, voice rest. If response is inadequate, microlaryngeal surgery.
Vocal-cord polyp/cyst: surgery is primary; voice-therapy integration follows.
Laryngopharyngeal reflux: PPI (8–12 weeks) + lifestyle (no late dinner, head elevation, weight loss, trigger-food elimination).
Vocal-cord paralysis: medialisation procedures (hyaluronic acid injection, type I thyroplasty, arytenoid adduction).
Pre-malignant lesion (leukoplakia, dysplasia): microlaryngeal excision + biopsy + close follow-up.
Frequently Asked Questions
- Acute viral laryngitis: 1–2 weeks. LPR with PPI: 4–8 weeks. Vocal-cord nodule with voice therapy: 8–12 weeks. Vocal-cord polyp with surgery: 4 weeks of post-op recovery.
- 30–90 minutes under general anaesthesia. Same-day discharge.
- 7–10 days voice rest → voice therapy begins (4 weeks) → most patients normal at 6–8 weeks. Professional voice users return to stage performance at 8–12 weeks.
- Laryngopharyngeal reflux causes oedema and inflammation on posterior vocal cords. Hoarseness worse in the morning, throat burning, chronic cough are typical. PPI + lifestyle is the foundational treatment.
- Very harmful. Chronic laryngitis, Reinke oedema, and laryngeal cancer risk all increase substantially. After cessation, voice quality improvement begins in 6–12 months.
- Annual baseline stroboscopy, early evaluation at first symptoms, voice-coach coordination, pre/post-stage vocal-hygiene protocol.
References
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