Friday, January 9, 2009

Voice Problems Should Never Be Ignored

Hoarseness is an annoyance that many people tend to ignore, but any persistent abnormal change in the voice—including a breathy, raspy, or strained quality—should be evaluated by a doctor, experts say. And the onus may be on you to ask for a voice evaluation, as a new study finds that primary care doctors often don't examine their patients for voice problems.

"What people should know is that a little hoarseness can be the sign of a big problem," says Richard Rosenfeld, professor and chairman of otolaryngology at Long Island College Hospital in Brooklyn, N.Y., and one of the authors of clinical practice guidelines for treating hoarseness that were published in September in Otolaryngology-Head and Neck Surgery. 
Voice problems affect about 30 percent of people in their lifetimes, and these issues can limit productivity in the workplace and damage quality of life. In the new study, researchers asked primary care physicians how often they routinely evaluate patients for problems with their voices. Just a third of the 271 primary care doctors surveyed reported doing regular evaluations for voice problems, and about 1 in 5 said they never evaluate patients for voice disorders.
Hoarseness can have many different causes, including the perfectly benign cold, allergy, or gastroesophageal reflux. But hoarseness that lasts for more than three weeks can be a sign of serious problems such as laryngeal, thyroid, or lung cancer, cautions Seth Cohen, assistant professor of otolaryngology-head and neck surgery at the Duke Voice Care Center at Duke Medical Center and the researcher presenting the new study at a meeting this week. "It's not something to take lightly."
Here are five tips for dealing with hoarseness:
Speak up. One reason primary care doctors don't address hoarseness is that "patients don't complain about it," Cohen says. "Patients have to advocate for themselves." Listen to your voice. Does it feel different? Are you able to do your job? Do your family members tell you that your voice doesn't sound quite right? If so, make sure your doctor knows all of your symptoms after the three-week mark, Cohen says, and consider having an exam of your larynx, also known as the voice box. Some family physicians perform this exam, but if yours doesn't, ask for a referral to an otolaryngologist.
Protect your voiceYour voice needs water much as an automobile needs oil, Cohen says, to "help keep mucus thin and as lubricating as possible." Don't smoke if you're hoarse, and avoid secondhand smoke as well as throat clearing, coughing, shouting, and yelling. "You need to take care of your voice at least as [well] as you take care of your car," Rosenfeld says.
Don't take decongestants. The medications dry out the mucus membranes, and you want to keep the membranes and your vocal cords moist.
Don't equate degree of hoarseness with seriousness. "It's not the amount of hoarseness that you have," Rosenfeld says. "Simply because you're a little hoarse doesn't mean you can ignore it."
Consider voice training, a "vastly underutilized and underappreciated type of therapy that can help you recover your voice quickly," Rosenfeld says. These sessions, done with a speech-language pathologist, usually last from four to eight weeks. "Voice training teaches you how to use your voice in a safer and more effective way," Rosenfeld says.

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