Global Health Asia-Pacific Special Issue | Page 85


Hoarseness of voice

Diagram A : Whitish Leukoplakic Lesion Undergoing Laser Surgery
Diagram B : Immediately Post Laser Surgery for the Lesion in Diag A
Datuk Dr . Siow Seng Choon is a NSR registered Ear Nose Throat specialist with 25 years of experience at the Siow ENT Laser Surgery Specialist and performs major surgeries at the selected regional referral hospitals .

One morning you realise that your voice suddenly sounds raspy and has deteriorated to a whisper over time . It improves over few days with or without medication , but when the hoarseness persists over three to four weeks , it ’ s a good idea to ask for a referral from your local GP to see an Ear , Nose , and Throat Specialist ( ENT ). That ’ s because hoarseness can be more than a temporary nuisance and results from numerous treatable problems .

Hoarseness or dysphonia is due to a malfunction of the vocal cords in the voice box , also called the larynx . When air is moving through the larynx , it causes the vocal cords to vibrate , thus generating voice . The vocal cords also help to close the airway during swallowing to stop you from breathing in food or liquid . If the vocal cords become swollen , inflamed , develop growths , or can ’ t move as they should to function properly , these might cause hoarseness .
Hoarseness has many reasons that require a diagnosis and treatment that will depend on what ’ s causing the voice change .
There are many causes to hoarseness , such as an ongoing infection , laryngitis , smoking , allergies , other irritants , and persistent vocal strain . It can also be caused by growths along the vocal folds that include small vocal cord swellings ( polyps ), callus patches ( nodules ), small encapsulated lesions ( cysts ), white patches on the vocal cords ( leucoplakia ), Reinke ’ s oedema ( swollen vocal cords that may be due to phono trauma from excessive talking , shouting , smoking , or gastric refluxes ) or vocal cord paralysis .
During your doctor ’ s visit , an ENT specialist will ask you about your voice problems and do an exam with a fine fibreoptic video endoscope to have a direct visualisation of the vocal cords or , if needed , a video stroboscope to evaluate the vocal cords in slow motion .
Depending on the diagnosis , your ENT doctor will
Diagram C : Granuloma at the False Cord
Diagram E : Polypoidal Masses on the Vocal Cord That Require Surgery
Diagram G : Sulcus Vocalis with persistent Hoarseness
Diagram D : Post Laser Excision of the Granuloma ( Diagram C )
Diagram F : A Large Vocal Cord Cyst Causing Hoarseness
Diagram H : Bilateral Vocal Cord Nodules causing Hoarseness
suggest one or more treatments , mainly rest , liquids , and voice therapy , such as how to use the voice better , how to clear the throat and how much liquid to drink , allergy treatments , cessation of smoking or related medical treatments with antibiotics , and anti-inflammatory or anti-gastric reflux medications . Lesions often heal by avoiding irritants and with voice therapy . Surgery may be needed to remove persistent lesions .
A specialised vocal cord surgery , Micro Laryngeal Surgery , assisted by Carbon Dioxide Laser , can also be performed on certain vocal cord tumours when indicated . This allows the removal of the growth while leaving intact most of the underlying tissue .
Hoarseness of voice must not be neglected as delayed diagnosis and treatment can lead to greater health risks .
GlobalHealthAsiaPacific . com ISSUE 6 | 2022