Recurring Hoarseness: Is There An Issue with the Vocal Cords?

Recurring Hoarseness

QUESTION: I have acid reflux, small hiatal hernia, and GERD.  I am a female senior and I have been suffering from recurring hoarseness.  When I feel stressed I believe it tightens up my vocal cords and I sound raspy, and it is very embarrassing.  What can I do?  Is there anything to permanently cure this?  Have my vocal cords atrophied?

First of all, thank you for your question. There are many reasons that one can have problems with your voice- as you describe.

The vocal cords are muscles, covered with a thin membrane. When we breathe the vocal cords open and when we speak the vocal cords come together. They must come together smoothly and close completely for a normal voice. Anything that keeps the vocal cords from coming together smoothly will affect your voice quality. The first thing one needs to be certain of is that there is no tumor, nodule or polyp on one or both cords. This will keep the cords from closing completely, and leave the speaker with a hoarse or raspy voice. At times one can push through this by forcing the cords closed- but the more this is done, the more hoarse one gets.

A hiatal hernia, or a weakness in the valve that keeps acid in the stomach, can cause reflux of acid contents as high as the voice box. Should the acid – even a small amount- hit the vocal cords, it causes irritation, swelling of the cords and hoarseness. It often causes the feeling that we have to clear our throat- and clearing the throat bangs the cords together and actually makes the swelling and voice worse. Treatment for reflux- diet, positional and at times medication can help this.

The vocal cords are muscles, and like any muscle, they can lose bulk. In that case, which is quite common, the vocal cords do not close completely without forcing- and this can also cause symptoms as you describe. At times one can force through this, but then the muscles fatigue and the voice gives out. This may respond to vocal exercises- and sometimes your ENT voice specialist may recommend a procedure to “bulk up” the cords so that they can close more readily.

Other less common causes include neurologic issues (stroke, Parkinson’s, neuropathies) that can cause similar complaints. Obviously, I cannot tell you if the problem is one or more of these issues. Clearly, the most important first step is to have your ENT doctor closely examine you and your vocal cords and figure out the cause of your vocal problems- and then together with you figure out how to help.

I hope this helps clears things up.

Robert L Pincus MD
NY Otolaryngology Group