A normal voice is produced when a person exhales with normal strength through the two vocal cords which are pulled tightly together. As air passes through the narrow slit between the vocal cords, the lining of the cords move with a wave-like motion. When the waves are in sync with one another, a clear voice is produced.
Hoarseness and other of voice disorders can present in several different ways. Some patients may present with a voice that is breathy, possibly indicating a loss of function or palsy of one of the vocal cords. A breathy voice may occur after thyroid, carotid, or other neck surgery, and it may occur after a viral infection that may impact the nerve that controls the vocal cords. Treatment for a vocal cord palsy or paralysis can include voice therapy to strengthen the unaffected vocal cord, or interventions (both temporary and permanent) to push the non-functioning vocal cord closer to the functioning one. A strained and tight voice can result from excessive muscle tone within the larynx (voice box). This can be treated with voice therapy, but rarely Botox injections are needed to restore a more normal voice.
A raspy or gravelly voice is much more common than a breathy one. A raspy voice occurs when the wave motion of the vocal cord lining is out of sync from one side to the other. This can occur from inflammation in the larynx from infection or acid reflux into the larynx. Growths or thickenings of the vocal cords can also produce a raspy voice. The most common of these is benign vocal cord nodules, which are reactive swellings of the vocal cords, somewhat analogous to calluses, from poor vocal hygiene or vocal abuse. These respond well to voice rest, good hydration, stomach acid reduction, and voice therapy when severe or not improving.
Growths on the vocal cords can also cause a raspy voice. Vocal cord polyps, which are smooth, benign swellings off one or both vocal cords, can occur from excessive voice use or a combination of factors including smoking and acid reflux. Benign tumors of the larynx are relatively uncommon, but can cause voice abnormalities. Malignant tumors of the larynx, i.e. cancer, most commonly occurs in smokers and former smokers.
It is reasonable to give a new-onset hoarse voice, in the absence of other more worrisome symptoms like shortness of breath, two weeks to resolve by itself. Beyond that, an examination by an Ear, Nose and Throat specialist (Otolaryngologist) is recommended. The larynx can frequently be examined with an examination mirror, but usually a flexible endoscope is needed for a more complete examination. This is performed easily and comfortably in the office, with topical anesthesia being applied to the inside of the nose prior to the examination. Should a growth or suspected tumor be identified, then biopsies or removal of these lesions would be performed in an operating room setting under general anesthesia. These are almost always ambulatory procedures, and can be safely performed in free-standing ambulatory surgery centers, as long as the anesthesia staff is experienced and comfortable in the airway management of these patients. Postoperative care generally includes one week or more of complete voice rest and good hydration.