Q & A

If you have a question or concern, send us an email. A doctor from one of our centers will answer your question in confidence. We may post the Q & A on the blog if space permits to help others who may have the same question, but will not use your name.

Sudden Hoarseness and Oral Candidiasis

Question:

My baby developed sudden hoarseness of voice then developed oral candidiasis then fever. After treatment, the candidiasis and fever were gone, but after about 3 weeks still has hoarseness. It should be known that he has attopic dermatitis and he was on hydrocortisone therapy, but we stopped that too for more than 3 weeks.

Best regards

Answer:

I would suggest a consultation with an ENT specialist who sees babies. It may just take a little longer for the hoarseness to improve but an otolaryngologist could examine the voice box in the office with a Fiberoptic telescope.

Hope this helps clear things up.

Scott D. Gold, MD

Q & A

I have a cyst on my arytenoid (in the larynx or voice box)

Question: I have been diagnosed with a mucosal retention larynx cyst on my arytenoid process. I know it has been there at least 1.5 yrs (I could feel it when breathing hard – it restricted my breathing) but I just had it checked out recently. The CAT scan showed it was @1.1 cm in diameter. My Dr. says I should have it removed and that it is a “simple” procedure. I am most worried about the general anesthesia and possible damage to my teeth or trachea or wherever else the breathing tube goes. So 2 questions: 1) Do you think I should get a 2nd opinion? and 2), is a larynx cyst ever aspirated instead of cut out? Thanks you so much for your thoughts.

Answer:

The arytenoids are paired cartilages that attach to the back of the vocal cords. By moving the arytenoids, we move the vocal cords- apart for breathing and together for speaking. While there can be a cyst (mucous containing sac) on an arytenoid- one more commonly sees granulomas- which are areas of inflammation. Granulomas usually come from reflux- and treatment for reflux will often get these to resolve without intervention. A larynx cyst comes from tissue getting filled with mucous from one of the many many mucous secreting tiny glands throughout the airway. Usually after some type of trauma to the tissues- swallowing the wrong way, acid reflux or some other unknown cause.

While a larynx cysts can be a tumor or even a cancer, this one clearly is felt to be nothing worrisome. If there is a question of there being a tumor or cancer, clearly one should have it removed.

Otherwise, I would suggest removing this should it be growing or causing symptoms- such as hoarseness, difficulty breathing or discomfort. Removing the cyst is a relatively easy, quick, simple procedure and can be done by most Ear Nose and Throat surgeons- or by a Laryngologist (subspecialist in voice) It almost always is done with general anesthesia- and the risks are basically as you describe- but they are quite rare-

Removing the cyst involves taking the top off, so that it drains and heals open. Usually, this would take a couple of minutes, total. There is no advantage to to aspirating (suctioning out the cyst) as it is likely to refill- and is not really much less of a procedure.

In general, it never hurts to get another opinion…

I hope this helps clear things up.

Robert Pincus MD
Associate Professor Otolaryngology
NY Otolaryngology Group/ NY Voice Center

Q & A

My voice has too high a pitch- what can I do?

Question: I am 19 years old, male. I have a high pitched male voice, I mean I am misunderstood as a lady most frequently when I answer the phone. this has been a great concern to me since most of my life but it really affected me after my friends got their voices roughen. And also once I am too tired or under a pressure situation words don’t come out, time to time once or two comes out, in these occasions people ask whether I am ill. Now I am fed up of this situation. Please……..can I know what the reason might be for this? Can I get a remedy for this, specially a non surgical one, please help me…….

Answer: As a young male enters puberty, there is a change in the voice box (or larynx) that general makes the voice become lower in pitch. This is the same change that makes a male’s “adam’s apple” more visible at this time. In some, the change comes earlier and in others, later.

Having a voice that is “too high” can be quite stressful for a young man. However, in most this will resolve- If not, we would first recommend speech therapy, to help change how you use your vocal cords.

If that should fail, there is a simple surgical procedure, a type of thryoplasty, which removes some of the tension on the vocal cords and is generally successful in lowering pitch of a high pitched male voice.

I hope this clears things up.

Robert Pincus MD

Q & A

My 5 month’s voice has gone hoarse after a long crying episode

Question: My 5 month’s voice has gone hoarse after a long crying episode. It happened about two days ago and I think his voice sounds raspy now and not as hoarse. He seems to have a hard time making the same high pitched sounds he used to be able to make during spontaneous vocalizations and during vocal play. What should I do, is this kind of hoarseness in infants common? Any help from your specialists would be greatly appreciated. Thank you!

Answer: Thanks for your question. Hoarseness for infants is not uncommon. It i quite comon for anyone, babies included, to develop hoarseness after vocal abuse. Certainly a long crying episode would fit.

When we breath- our vocal cords open to allow air to pass. When we speak or make noise, the vocal cords come together. They must come together smoothly for us to have a normal voice. However, when we speak loudly, or yell (or cry) – we are often banging the vocal cords together. This causes swelling, so that the closure becomes uneven and we percieve hoarseness. Most often, this is temporary, until the swelling goes down. Sometimes, we can develop a nodule or a polyp from this- which is really like a callus on the vocal cords. This would cause the poor voice to persist.

Using your voice minimally (modified voice rest) would help in the healing process. However, it is really impossible to get your baby to do so.

Almost always, his voice will come back to normal over the next few days or a week. If not, he should have an ear nose and throat doctor take a look at the vocal cords, (laryngoscopy) to make sure there has been no significant damage.

I hope this clears things up.

Robert Pincus MD

Associate Professor Otolaryngology NY Medical College

NY Otolaryngology Group

Q & A

Hoarseness for a Month — Should I See a Specialist?

Question: I had a cough during the first week of the New Year and I lost my voice for about a week. Since then, I get my voice back very slowly and it had been exactly a month now but I still don’t have my full voice. My current voice sounds like I smoked for that last 30 years (I never smoked) and it faded when I try to raise my voice or say something at a higher pitch. Other than the voice change, I feel no other symptoms, even during my cough. I just have had this hoarseness for a month now.

Is this something I should check with a specialist?

Answer:

After experiencing hoarseness for a month, you should visit a doctor to have an examination. While everyone has experienced hoarseness at some point in their life, usually the problem goes away with some rest and self-care after several days. Current guidelines state that anyone with hoarseness that persists for more than two to three weeks should have an evaluation to find the root cause. While hoarseness is often a result of numerous treatable conditions, it could also be a sign of cancer. While cancer isn’t as likely, it is still wise to get checked out. Early detection will always improve your odds of successful treatment.

Some of the common causes of having a hoarse throat for an extended period of time include:

Vocal cords losing fullness and tension due to age.
Chronic irritation of vocal cords, caused by smoking, allergies, GERD, etc.
Spasm of the vocal cord muscle
Cancer
Complications from other diseases such as MS, hypothyroidism, rheumatoid arthritis, etc.

Rather than repeating the entire discussion here, let me send you to the part of our web site that discusses this problem so you can get more information.

www.nyogmd.com/library/hoarseness/

I hope this helps.

Robert Pincus MD

Associate Professor Otolaryngology

NY Voice Center/ NY Sinus Center

Q & A

Causes (And Treatments) For Your Baby’s Hoarse Voice

Unfortunately, even though infants don’t possess fully developed vocal skills, they’re not immune to the hoarseness and vocal problems that can plague adults. If you notice that your infant has a raspy voice, there are a number of simple causes and solutions for that hoarse baby voice.

Common Causes of Hoarse Baby Voice

Prolonged crying. Although all infants cry, some do so more frequently, especially when suffering from colic. Excessive crying can lead to swollen vocal cords and a raspy voice. Once infants rest their voices, the hoarseness can diminish. Many infants outgrow phases of heavy crying on their own.
Acid reflux. Gastroesophageal disease, or acid reflux, is common in babies, and severe or frequent attacks can lead to a raspy voice. Although the condition occurs in many infants, it’s important to visit a doctor if you suspect acid reflux in your infant; the child’s eating and sleeping patterns also can be disrupted. Diet changes and medication often offer relief.
Vocal cord nodules. When the voice is used excessively, including from long crying spells, callous-like nodules can grow on the vocal cords and prevent them from functioning effectively. Vocal rest is usually recommended for these nodules, meaning that treatment can be difficult in infants, who cannot directly comprehend medical instructions. Check with a doctor if hoarseness persists – though in this condition, many infants must outgrow their crying before finding ease.
Allergies. Symptoms of allergies, including post-nasal drip, can lead to vocal-cord irritation and swelling. Hoarseness and other complications can result, so it’s especially important to consult a doctor to determine the cause of any allergic reactions.

Any general illness – even a cold – can be linked to hoarseness if it means your infant is suffering from congestion and a post-nasal drip. The accompanying raspy voice and discomfort should both pass once the illness does.

If your infant is experiencing vocal trouble, including signs of hoarseness, then feel free to contact our office anytime for personalized advice.

Sources:

http://www.livestrong.com/article/244436-causes-of-hoarseness-in-infants/

http://heartburn.about.com/od/infantschildrenandreflux/a/refluxininfants.htm