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ASK THE DOCTOR: Don't hoarse around with your voice
By DR. JIM MITTERANDO

Q. I am a school teacher who often gets hoarse whenever I have a cold. What can I do? Should I be concerned?

A. Since you are a teacher, you cannot simply stop talking when you are hoarse. But you can:

  • Speak more gently
  • Avoid yelling
  • Consider using a microphone if you need to project your voice
  • Minimize your speech
  • Avoid clearing your throat and coughing
  • Avoid loud or prolonged whispering that further strains the vocal cords
  • Suck on hard card candy to keep the throat moist and reduce the desire to clear your throat or cough
  • Use cough suppressants if you have a cough
  • Do not gargle, this strains the vocal cords
  • Do not smoke. This irritates the vocal cords

Hoarseness during a cold often sounds worse than it is. In fact, temporary hoarseness is not harmful or worrisome; it is a sign of a viral illness that does not require any medical treatment. More serious infections such as strep throat do not cause hoarseness.

You should see a doctor for persistent hoarseness. Common causes of persistent hoarseness include acid reflux, smoking, vocal cord nodules from overuse (akin to calluses) or chronic postnasal drip.

Treatment for acid reflux include: smaller meals, avoid lying down for at least three hours after eating, lose weight, avoid caffeine and possible medications to decrease acid production such as ranitidine (Zantac) and omeprazole (Prilosec).

Smoking can cause polyps on the vocal cords as well as cancer of the throat. Quitting smoking often resolves hoarseness.

Vocal cord nodules due to overuse require behavioral changes and often speech therapy to learn how to undo harmful habits that abuse your vocal cords. Occasionally surgery is required to remove vocal cord nodules or polyps.

Postnasal drip may be treated with a nasal steroid spray. Other causes of persistent hoarseness include thyroid problems, vocal cord spasms or nerve damage. Aging also affects the voice and may result in quivering or hoarseness.

When you speak, the vocal cords form sound through their movement and vibration. Hoarseness (abnormal voice changes) occurs when your vocal cords do not work properly. Laryngitis - swelling of the vocal cords - is the most common cause of hoarseness often due to a common cold virus infection or occasionally from overuse or yelling.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2004 The Patriot Ledger
Transmitted Tuesday, March 02, 2004