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vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Diagnosis</span> </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Diagnosis subsection</span> </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-Definition" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Definition"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Definition</span> </div> </a> <ul id="toc-Definition-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Auditory-perceptual_measures" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Auditory-perceptual_measures"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>Auditory-perceptual measures</span> </div> </a> <ul id="toc-Auditory-perceptual_measures-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Vocal_fold_imaging" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Vocal_fold_imaging"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.3</span> <span>Vocal fold imaging</span> </div> </a> <ul id="toc-Vocal_fold_imaging-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Acoustic_measures" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Acoustic_measures"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.4</span> <span>Acoustic measures</span> </div> </a> <ul id="toc-Acoustic_measures-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Aerodynamic_measures" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Aerodynamic_measures"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.5</span> <span>Aerodynamic measures</span> </div> </a> <ul id="toc-Aerodynamic_measures-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prevention" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Prevention"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Prevention</span> </div> </a> <ul id="toc-Prevention-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Treatment</span> </div> </a> <button aria-controls="toc-Treatment-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Treatment subsection</span> </button> <ul id="toc-Treatment-sublist" class="vector-toc-list"> <li id="toc-Direct_therapies" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Direct_therapies"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.1</span> <span>Direct therapies</span> </div> </a> <ul id="toc-Direct_therapies-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Indirect_therapies" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Indirect_therapies"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.2</span> <span>Indirect therapies</span> </div> </a> <ul id="toc-Indirect_therapies-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Medication_and_surgery" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Medication_and_surgery"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.3</span> <span>Medication and surgery</span> </div> </a> <ul id="toc-Medication_and_surgery-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Epidemiology</span> </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span 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Available in 32 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-32" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">32 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%A8%D8%AD%D8%A9" title="بحة – Arabic" lang="ar" hreflang="ar" data-title="بحة" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%94%D0%B8%D1%81%D1%84%D0%BE%D0%BD%D0%B8%D1%8F" title="Дисфония – Bulgarian" lang="bg" hreflang="bg" data-title="Дисфония" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target"><span>Български</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Disfonia" title="Disfonia – Catalan" lang="ca" hreflang="ca" data-title="Disfonia" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Dysfonie" title="Dysfonie – Czech" lang="cs" hreflang="cs" data-title="Dysfonie" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Dysphonie" title="Dysphonie – German" lang="de" hreflang="de" data-title="Dysphonie" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/D%C3%BCsfoonia" title="Düsfoonia – Estonian" lang="et" hreflang="et" data-title="Düsfoonia" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target"><span>Eesti</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Disfon%C3%ADa" title="Disfonía – Spanish" lang="es" hreflang="es" data-title="Disfonía" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/Disfonio" title="Disfonio – Esperanto" lang="eo" hreflang="eo" data-title="Disfonio" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target"><span>Esperanto</span></a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Disfonia" title="Disfonia – Basque" lang="eu" hreflang="eu" data-title="Disfonia" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target"><span>Euskara</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%AF%DB%8C%D8%B3%D9%81%D9%88%D9%86%DB%8C" title="دیسفونی – Persian" lang="fa" hreflang="fa" data-title="دیسفونی" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Dysphonie" title="Dysphonie – French" lang="fr" hreflang="fr" data-title="Dysphonie" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ga mw-list-item"><a href="https://ga.wikipedia.org/wiki/Diosf%C3%B3ine" title="Diosfóine – Irish" lang="ga" hreflang="ga" data-title="Diosfóine" data-language-autonym="Gaeilge" data-language-local-name="Irish" class="interlanguage-link-target"><span>Gaeilge</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EC%89%B0%EB%AA%A9%EC%86%8C%EB%A6%AC" title="쉰목소리 – Korean" lang="ko" hreflang="ko" data-title="쉰목소리" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%B8%E0%A5%8D%E0%A4%B5%E0%A4%B0_%E0%A4%AC%E0%A5%88%E0%A4%A0%E0%A4%A8%E0%A4%BE/%E0%A4%97%E0%A4%B2%E0%A4%BE_%E0%A4%AC%E0%A5%88%E0%A4%A0%E0%A4%A8%E0%A4%BE" title="स्वर बैठना/गला बैठना – Hindi" lang="hi" hreflang="hi" data-title="स्वर बैठना/गला बैठना" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target"><span>हिन्दी</span></a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Disfonija" title="Disfonija – Croatian" lang="hr" hreflang="hr" data-title="Disfonija" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target"><span>Hrvatski</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Suara_serak" title="Suara serak – Indonesian" lang="id" hreflang="id" data-title="Suara serak" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Disfonia" title="Disfonia – Italian" lang="it" hreflang="it" data-title="Disfonia" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%A6%D7%A8%D7%99%D7%93%D7%95%D7%AA" title="צרידות – Hebrew" lang="he" hreflang="he" data-title="צרידות" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-hu mw-list-item"><a href="https://hu.wikipedia.org/wiki/Diszf%C3%B3nia" title="Diszfónia – Hungarian" lang="hu" hreflang="hu" data-title="Diszfónia" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target"><span>Magyar</span></a></li><li class="interlanguage-link interwiki-mk mw-list-item"><a href="https://mk.wikipedia.org/wiki/%D0%97%D0%B0%D1%80%D0%B8%D0%BF%D0%BD%D0%B0%D1%82%D0%BE%D1%81%D1%82" title="Зарипнатост – Macedonian" lang="mk" hreflang="mk" data-title="Зарипнатост" data-language-autonym="Македонски" data-language-local-name="Macedonian" class="interlanguage-link-target"><span>Македонски</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Heesheid" title="Heesheid – Dutch" lang="nl" hreflang="nl" data-title="Heesheid" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Chrypka" title="Chrypka – Polish" lang="pl" hreflang="pl" data-title="Chrypka" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Disfonia" title="Disfonia – Portuguese" lang="pt" hreflang="pt" data-title="Disfonia" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Hripavost" title="Hripavost – Slovenian" lang="sl" hreflang="sl" data-title="Hripavost" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target"><span>Slovenščina</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%94%D0%B8%D1%81%D1%84%D0%BE%D0%BD%D0%B8%D1%98%D0%B0" title="Дисфонија – Serbian" lang="sr" hreflang="sr" data-title="Дисфонија" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Disfonija" title="Disfonija – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Disfonija" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target"><span>Srpskohrvatski / српскохрватски</span></a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/K%C3%A4heys" title="Käheys – Finnish" lang="fi" hreflang="fi" data-title="Käheys" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target"><span>Suomi</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Heshet" title="Heshet – Swedish" lang="sv" hreflang="sv" data-title="Heshet" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%A5%D1%80%D0%B8%D0%BF%D0%BB%D0%B8%D0%B9_%D0%B3%D0%BE%D0%BB%D0%BE%D1%81" title="Хриплий голос – Ukrainian" lang="uk" hreflang="uk" data-title="Хриплий голос" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target"><span>Українська</span></a></li><li class="interlanguage-link interwiki-vi mw-list-item"><a href="https://vi.wikipedia.org/wiki/Kh%C3%A0n_gi%E1%BB%8Dng" title="Khàn giọng – Vietnamese" lang="vi" hreflang="vi" data-title="Khàn giọng" data-language-autonym="Tiếng Việt" data-language-local-name="Vietnamese" class="interlanguage-link-target"><span>Tiếng Việt</span></a></li><li class="interlanguage-link interwiki-yi mw-list-item"><a href="https://yi.wikipedia.org/wiki/%D7%94%D7%99%D7%99%D7%96%D7%A2%D7%A8%D7%99%D7%92" title="הייזעריג – Yiddish" lang="yi" hreflang="yi" data-title="הייזעריג" data-language-autonym="ייִדיש" data-language-local-name="Yiddish" class="interlanguage-link-target"><span>ייִדיש</span></a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E5%A3%B0%E9%9F%B3%E5%98%B6%E5%93%91" title="声音嘶哑 – Chinese" lang="zh" hreflang="zh" data-title="声音嘶哑" data-language-autonym="中文" data-language-local-name="Chinese" class="interlanguage-link-target"><span>中文</span></a></li> </ul> <div class="after-portlet after-portlet-lang"><span class="wb-langlinks-edit wb-langlinks-link"><a href="https://www.wikidata.org/wiki/Special:EntityPage/Q836379#sitelinks-wikipedia" title="Edit interlanguage links" class="wbc-editpage">Edit links</a></span></div> </div> </div> </div> </header> <div class="vector-page-toolbar"> <div class="vector-page-toolbar-container"> <div id="left-navigation"> <nav aria-label="Namespaces"> <div id="p-associated-pages" class="vector-menu 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div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">"Hoarse" redirects here. For the album by 16 Horsepower, see <a href="/wiki/Hoarse_(album)" title="Hoarse (album)">Hoarse (album)</a>.</div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Hoarse voice</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data">Hoarseness, dysphonia</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Otolaryngology" class="mw-redirect" title="Otolaryngology">Otolaryngology</a></td></tr></tbody></table> <p>A <b>hoarse voice</b>, also known as <b>dysphonia</b> or <b>hoarseness</b>,<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> is when the voice involuntarily sounds breathy, raspy, or strained, or is softer in volume or lower in pitch.<sup id="cite_ref-:03_2-0" class="reference"><a href="#cite_note-:03-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup><sup class="noprint Inline-Template" style="margin-left:0.1em; white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Please_clarify" title="Wikipedia:Please clarify"><span title="The text near this tag may need clarification or removal of jargon. (October 2019)">clarification needed</span></a></i>]</sup> A hoarse voice can be associated with a feeling of unease or scratchiness in the throat.<sup id="cite_ref-:03_2-1" class="reference"><a href="#cite_note-:03-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Hoarseness is often a symptom of problems in the vocal folds of the larynx.<sup id="cite_ref-:03_2-2" class="reference"><a href="#cite_note-:03-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> It may be caused by <a href="/wiki/Laryngitis" title="Laryngitis">laryngitis</a>, which in turn may be caused by an <a href="/wiki/Upper_respiratory_infection" class="mw-redirect" title="Upper respiratory infection">upper respiratory infection</a>, a <a href="/wiki/Common_cold" title="Common cold">cold</a>, or <a href="/wiki/Allergies" class="mw-redirect" title="Allergies">allergies</a>.<sup id="cite_ref-:03_2-3" class="reference"><a href="#cite_note-:03-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Cheering at sporting events, speaking loudly in noisy environments, talking for too long without resting one's voice, singing loudly, or speaking with a voice that is too high or too low can also cause temporary hoarseness.<sup id="cite_ref-:03_2-4" class="reference"><a href="#cite_note-:03-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> A number of other causes for losing one's voice exist, and treatment is generally by resting the voice and treating the underlying cause.<sup id="cite_ref-:03_2-5" class="reference"><a href="#cite_note-:03-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> If the cause is misuse or overuse of the voice, drinking plenty of water may alleviate the problems.<sup id="cite_ref-:03_2-6" class="reference"><a href="#cite_note-:03-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>It appears to occur more commonly in females and the elderly.<sup id="cite_ref-cohen_4-0" class="reference"><a href="#cite_note-cohen-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Furthermore, certain occupational groups, such as teachers and singers, are at an increased risk.<sup id="cite_ref-williams_5-0" class="reference"><a href="#cite_note-williams-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-verdolini_6-0" class="reference"><a href="#cite_note-verdolini-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>Long-term hoarseness, or hoarseness that persists over three weeks, especially when not associated with a cold or <a href="/wiki/Influenza" title="Influenza">flu</a> should be assessed by a medical doctor.<sup id="cite_ref-:03_2-7" class="reference"><a href="#cite_note-:03-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> It is also recommended to see a doctor if hoarseness is associated with coughing up blood, <a href="/wiki/Dysphagia" title="Dysphagia">difficulties swallowing</a>, a lump in the neck, pain when speaking or swallowing, <a href="/wiki/Respiratory_distress" class="mw-redirect" title="Respiratory distress">difficulty breathing</a>, or <a href="/wiki/Aphonia" title="Aphonia">complete loss of voice</a> for more than a few days.<sup id="cite_ref-:03_2-8" class="reference"><a href="#cite_note-:03-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> For voice to be classified as "dysphonic", abnormalities must be present in one or more vocal parameters: pitch, loudness, quality, or variability.<sup id="cite_ref-aronson_7-0" class="reference"><a href="#cite_note-aronson-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Perceptually, dysphonia can be characterised by hoarse, breathy, harsh, or rough vocal qualities, but some kind of <a href="/wiki/Phonation" title="Phonation">phonation</a> remains.<sup id="cite_ref-aronson_7-1" class="reference"><a href="#cite_note-aronson-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p><p>Dysphonia can be categorized into two broad main types: organic and functional, and classification is based on the underlying pathology. While the causes of dysphonia can be divided into five basic categories, all of them result in an interruption of the ability of the <a href="/wiki/Vocal_folds" class="mw-redirect" title="Vocal folds">vocal folds</a> to vibrate normally during exhalation, which affects the voice. The assessment and diagnosis of dysphonia is done by a multidisciplinary team, and involves the use of a variety of subjective and objective measures, which look at both the quality of the voice as well as the physical state of the <a href="/wiki/Larynx" title="Larynx">larynx</a>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2016)">citation needed</span></a></i>]</sup> Multiple treatments have been developed to address organic and functional causes of dysphonia. Dysphonia can be targeted through direct therapy, indirect therapy, medical treatments, and surgery. Functional dysphonias may be treated through direct and indirect voice therapies, whereas surgeries are recommended for chronic, organic dysphonias.<sup id="cite_ref-:2_8-0" class="reference"><a href="#cite_note-:2-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Types">Types</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hoarse_voice&action=edit&section=1" title="Edit section: Types"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Voice disorders can be divided into two broad categories: organic and functional.<sup id="cite_ref-:32_9-0" class="reference"><a href="#cite_note-:32-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> The distinction between these broad classes stems from their cause, whereby organic dysphonia results from some sort of physiological change in one of the subsystems of speech (for voice, usually respiration, laryngeal anatomy, and/or other parts of the vocal tract are affected). Conversely, functional dysphonia refers to hoarseness resulting from vocal use (i.e. overuse/abuse).<sup id="cite_ref-:7_10-0" class="reference"><a href="#cite_note-:7-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Furthermore, according to <a href="/wiki/American_Speech%E2%80%93Language%E2%80%93Hearing_Association" title="American Speech–Language–Hearing Association">ASHA</a>, organic dysphonia can be subdivided into structural and neurogenic; neurogenic dysphonia is defined as impaired functioning of the vocal structure due to a neurological problem (in the <a href="/wiki/Central_nervous_system" title="Central nervous system">central nervous system</a> or <a href="/wiki/Peripheral_nervous_system" title="Peripheral nervous system">peripheral nervous system</a>); in contrast, structural dysphonia is defined as impaired functioning of the vocal mechanism that is caused by some sort of physical change (e.g. a lesion on the vocal folds).<sup id="cite_ref-:7_10-1" class="reference"><a href="#cite_note-:7-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Notably, an additional subcategory of functional dysphonia recognized by professionals is psychogenic dysphonia, which can be defined as a type of voice disorder that has no known cause and can be presumed to be a product of some sort of psychological stressors in one's environment.<sup id="cite_ref-:7_10-2" class="reference"><a href="#cite_note-:7-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> It is important to note that these types are not mutually exclusive and much overlap occurs. For example, <a href="/wiki/Muscle_Tension_Dysphonia" class="mw-redirect" title="Muscle Tension Dysphonia">Muscle Tension Dysphonia</a> (MTD) has been found to be a result of many different causes including the following: MTD in the presence of an organic pathology (i.e. organic type), MTD stemming from vocal use (i.e. functional type), and MTD as a result of personality and/or psychological factors (i.e. psychogenic type).<sup id="cite_ref-:7_10-3" class="reference"><a href="#cite_note-:7-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:02_12-0" class="reference"><a href="#cite_note-:02-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col" style="column-width: 30em;"> <ul><li>Organic dysphonia <ul><li>Laryngitis (Acute: viral, bacterial) - (Chronic: smoking, <a href="/wiki/Gastroesophageal_reflux_disease" title="Gastroesophageal reflux disease">GERD</a>, <a href="/wiki/Laryngopharyngeal_reflux" title="Laryngopharyngeal reflux">LPR</a>)</li> <li>Neoplasm (Premalignant: dysplasia) - (Malignant: Squamous cell carcinoma)</li> <li>Trauma (Iatrogenic: surgery, intubation) - (Accidental: blunt, penetrating, thermal)</li> <li>Endocrine (Hypothyroidism, hypogonadism)</li> <li>Haematological (Amyloidosis)</li> <li>Iatrogenic (inhaled corticosteroids)</li></ul></li> <li>Functional dysphonia <ul><li>Psychogenic</li> <li>Vocal misuse</li> <li>Idiopathic</li></ul></li></ul></div> <div class="mw-heading mw-heading2"><h2 id="Causes">Causes</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hoarse_voice&action=edit&section=2" title="Edit section: Causes"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The most common causes of hoarseness is <a href="/wiki/Laryngitis" title="Laryngitis">laryngitis</a> (acute 42.1%; chronic 9.7%) and functional dysphonia (30%).<sup id="cite_ref-:10_13-0" class="reference"><a href="#cite_note-:10-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Hoarseness can also be caused by laryngeal <a href="/wiki/Tumours" class="mw-redirect" title="Tumours">tumours</a> (benign 10.7 - 31%; malignant 2.2 - 3.0%).<sup id="cite_ref-:10_13-1" class="reference"><a href="#cite_note-:10-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Causes that are overall less common include <a href="/wiki/Neurogenic" class="mw-redirect" title="Neurogenic">neurogenic</a> conditions (2.8 - 8.0%), psychogenic conditions (2.0 - 2.2%), and aging (2%).<sup id="cite_ref-:10_13-2" class="reference"><a href="#cite_note-:10-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p><p>A variety of different causes, which result in abnormal vibrations of the vocal folds, can cause dysphonia. These causes can range from vocal abuse and misuse to <a href="/wiki/Systemic_disease" title="Systemic disease">systemic diseases</a>. Causes of dysphonia can be divided into five basic categories, although overlap may occur between categories.<sup id="cite_ref-14" class="reference"><a href="#cite_note-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:0_17-0" class="reference"><a href="#cite_note-:0-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> (Note that this list is not exhaustive): </p> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1184024115"><div class="div-col" style="column-width: 30em;"> <ol><li><a href="/wiki/Neoplasm" title="Neoplasm">Neoplastic</a>/structural: Abnormal growths of the vocal fold tissue. <ul><li><a href="/wiki/Dysplasia" title="Dysplasia">Dysplasia</a></li> <li><a href="/wiki/Cyst" title="Cyst">Cysts</a></li> <li>Polyps</li> <li><a href="/wiki/Vocal_fold_nodule" class="mw-redirect" title="Vocal fold nodule">Nodules</a></li> <li><a href="/wiki/Carcinoma" title="Carcinoma">Carcinoma</a></li></ul></li> <li><a href="/wiki/Inflammation" title="Inflammation">Inflammatory</a>: Changes in the vocal fold tissue as a result of inflammation. <ul><li><a href="/wiki/Allergy" title="Allergy">Allergy</a></li> <li><a href="/wiki/Infection" title="Infection">Infections</a></li> <li><a href="/wiki/Gastroesophageal_reflux_disease" title="Gastroesophageal reflux disease">Reflux</a></li> <li>Smoking</li> <li>Trauma</li> <li>Voice abuse</li></ul></li> <li>Neuromuscular: Disturbances in any of the components of the <a href="/wiki/Nervous_system" title="Nervous system">nervous system</a> that control laryngeal function. <ul><li><a href="/wiki/Multiple_sclerosis" title="Multiple sclerosis">Multiple Sclerosis</a></li> <li><a href="/wiki/Myasthenia_gravis" title="Myasthenia gravis">Myasthenia Gravis</a></li> <li><a href="/wiki/Parkinson%27s_disease" title="Parkinson's disease">Parkinson's disease</a></li> <li><a href="/wiki/Spasmodic_dysphonia" title="Spasmodic dysphonia">Spasmodic Dysphonia</a></li> <li><a href="/wiki/Nerve_injury" title="Nerve injury">Nerve injury</a></li></ul></li> <li>Associated Systemic Diseases: <a href="/wiki/Systemic_disease" title="Systemic disease">Systemic diseases</a> which have manifestations that affect the voice. <ul><li><a href="/wiki/Acromegaly" title="Acromegaly">Acromegaly</a></li> <li><a href="/wiki/Amyloidosis" title="Amyloidosis">Amyloidosis</a></li> <li><a href="/wiki/Hypothyroidism" title="Hypothyroidism">Hypothyroidism</a></li> <li><a href="/wiki/Sarcoidosis" title="Sarcoidosis">Sarcoidosis</a></li></ul></li> <li>Technical: Associated with poor muscle functioning or psychological stresses, with no corresponding physiological abnormalities of the larynx. <ul><li>Psychogenic such as dissociation disorder<sup id="cite_ref-18" class="reference"><a href="#cite_note-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup></li> <li>Excess demands</li> <li>Stress</li> <li>Vocal strain</li></ul></li></ol></div> <div class="mw-heading mw-heading3"><h3 id="Employment">Employment</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hoarse_voice&action=edit&section=3" title="Edit section: Employment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>It has been suggested that certain occupational groups may be at increased risk of developing dysphonia<sup id="cite_ref-williams_5-1" class="reference"><a href="#cite_note-williams-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-verdolini_6-1" class="reference"><a href="#cite_note-verdolini-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> due to the excessive or intense vocal demands of their work.<sup id="cite_ref-:15_19-0" class="reference"><a href="#cite_note-:15-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> Research on this topic has primarily focused on teachers and singers, although some studies have examined other groups of heavy voice users (e.g. actors, cheerleaders, aerobic instructors, etc.).<sup id="cite_ref-williams_5-2" class="reference"><a href="#cite_note-williams-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:12_20-0" class="reference"><a href="#cite_note-:12-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> At present, it is known that teachers and singers are likely to report dysphonia.<sup id="cite_ref-:15_19-1" class="reference"><a href="#cite_note-:15-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:14_21-0" class="reference"><a href="#cite_note-:14-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> Moreover, physical education teachers, teachers in noisy environments, and those who habitually use a loud speaking voice are at increased risk.<sup id="cite_ref-:15_19-2" class="reference"><a href="#cite_note-:15-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> The term <b><a href="/wiki/Pharyngitis#Classification" title="Pharyngitis">clergyman's throat</a></b> or <i>dysphonia clericorum</i> was previously used for painful dysphonia associated with public speaking, particularly among preachers.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> However, the exact prevalence rates for occupational voice users are unclear, as individual studies have varied widely in the methodologies used to obtain data (e.g. employing different <a href="/wiki/Operational_definition" title="Operational definition">operational definitions</a> for "singer").<sup id="cite_ref-:15_19-3" class="reference"><a href="#cite_note-:15-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:14_21-1" class="reference"><a href="#cite_note-:14-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Mechanism">Mechanism</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hoarse_voice&action=edit&section=4" title="Edit section: Mechanism"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Located in the anterior portion of the neck is the <a href="/wiki/Larynx" title="Larynx">larynx</a> (also known as the voice box), a structure made up of several supporting cartilages and ligaments, which houses the <a href="/wiki/Vocal_folds" class="mw-redirect" title="Vocal folds">vocal folds</a>.<sup id="cite_ref-colton_23-0" class="reference"><a href="#cite_note-colton-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> In normal voice production, exhaled air moves out of the lungs and passes upward through the <a href="/wiki/Vocal_tract" title="Vocal tract">vocal tract</a>.<sup id="cite_ref-colton_23-1" class="reference"><a href="#cite_note-colton-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> At the level of the larynx, the exhaled air causes the vocal folds to move toward the midline of the tract (a process called adduction). The adducted vocal folds do not close completely but instead remain partially open. The narrow opening between the folds is referred to as the <a href="/wiki/Glottis" title="Glottis">glottis</a>.<sup id="cite_ref-colton_23-2" class="reference"><a href="#cite_note-colton-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-aronson_7-2" class="reference"><a href="#cite_note-aronson-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> As air moves through the glottis, it causes a distortion of the air particles which sets the vocal folds into vibratory motion. It is this vibratory motion that produces phonation or voice.<sup id="cite_ref-aronson_7-3" class="reference"><a href="#cite_note-aronson-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> In dysphonia, there is an impairment in the ability to produce an appropriate level of phonation. More specifically, it results from an impairment in vocal fold vibration or the nerve supply of the larynx.<sup id="cite_ref-aronson_7-4" class="reference"><a href="#cite_note-aronson-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hoarse_voice&action=edit&section=5" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The assessment and diagnosis of a dysphonic voice is completed by a multidisciplinary team, such as an otolaryngologist (ear, nose and throat doctor) and Speech-Language Pathologist, involving the use of both objective and subjective measures to evaluate the quality of the voice as well as the condition of the vocal fold <a href="/wiki/Tissue_(biology)" title="Tissue (biology)">tissue</a> and <a href="/wiki/Vibration" title="Vibration">vibration</a> patterns.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Definition">Definition</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hoarse_voice&action=edit&section=6" title="Edit section: Definition"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Dysphonia is a broad clinical term which refers to abnormal functioning of the voice.<sup id="cite_ref-colton_23-3" class="reference"><a href="#cite_note-colton-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-aronson_7-5" class="reference"><a href="#cite_note-aronson-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> More specifically, a voice can be classified as "dysphonic" when there are abnormalities or impairments in one or more of the following parameters of voice: pitch, loudness, quality, and variability.<sup id="cite_ref-aronson_7-6" class="reference"><a href="#cite_note-aronson-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> For example, abnormal pitch can be characterized by a voice that is too high or low whereas abnormal loudness can be characterized by a voice that is too quiet or loud.<sup id="cite_ref-aronson_7-7" class="reference"><a href="#cite_note-aronson-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Similarly, a voice that has frequent, inappropriate breaks characterizes abnormal quality while a voice that is monotone (i.e., very flat) or inappropriately fluctuates characterizes abnormal variability.<sup id="cite_ref-aronson_7-8" class="reference"><a href="#cite_note-aronson-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> While hoarseness is used interchangeably with the term dysphonia, it is important to note that the two are not synonymous. Hoarseness is merely a subjective term to explain the perceptual quality (or sound) of a dysphonic voice.<sup id="cite_ref-schwartz_25-0" class="reference"><a href="#cite_note-schwartz-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> While hoarseness is a common symptom (or complaint) of dysphonia,<sup id="cite_ref-colton_23-4" class="reference"><a href="#cite_note-colton-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> there are several other signs and symptoms that can be present such as: breathiness, roughness, and dryness. Furthermore, a voice can be classified as dysphonic when it poses problems in the functional or occupational needs of the individual or is inappropriate for their age or sex.<sup id="cite_ref-aronson_7-9" class="reference"><a href="#cite_note-aronson-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Auditory-perceptual_measures">Auditory-perceptual measures</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hoarse_voice&action=edit&section=7" title="Edit section: Auditory-perceptual measures"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Auditory-perceptual measures are the most commonly used tool by clinicians to evaluate the voice quality due to its quick and non-invasive nature.<sup id="cite_ref-:4_26-0" class="reference"><a href="#cite_note-:4-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> Additionally, these measures have been proven to be reliable in a clinical setting.<sup id="cite_ref-:3_27-0" class="reference"><a href="#cite_note-:3-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> Ratings are used to evaluate the quality of a patient's voice for a variety of voice features, including overall severity, roughness, breathiness, strain, loudness and pitch. These evaluations are done during spontaneous speech, sentence or passage reading or sustained vowel productions.<sup id="cite_ref-:0_17-1" class="reference"><a href="#cite_note-:0-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> The GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) and the CAPE-V (Consensus Auditory Perceptual Evaluation—Voice) are two formal voice rating scales commonly used for this purpose.<sup id="cite_ref-:4_26-1" class="reference"><a href="#cite_note-:4-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Vocal_fold_imaging">Vocal fold imaging</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hoarse_voice&action=edit&section=8" title="Edit section: Vocal fold imaging"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Vocal fold imaging techniques are used by clinicians to examine the vocal folds and allows them to detect vocal <a href="/wiki/Pathology" title="Pathology">pathology</a> and assess the quality of the vocal fold vibrations. Laryngeal <a href="/wiki/Stroboscope" title="Stroboscope">stroboscopy</a> is the primary clinical tool used for this purpose. Laryngeal stroboscopy uses a synchronized flashing light passed through either a rigid or flexible <a href="/wiki/Laryngoscopy" title="Laryngoscopy">laryngoscope</a> to provide an image of the vocal fold motion; the image is created by averaging over several vibratory cycles and is thus not provided in real-time.<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> As this technique relies on <a href="/wiki/Periodic_function" title="Periodic function">periodic</a> vocal fold vibration, it cannot be used in patients with moderate to severe dysphonia.<sup id="cite_ref-:0_17-2" class="reference"><a href="#cite_note-:0-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> High speed digital imaging of the vocal folds (<a href="/wiki/Videokymography" title="Videokymography">videokymography</a>), another imaging technique, is not subject to the same limitations as laryngeal stroboscopy. A rigid endoscope is used to take images at a rate of 8000 frames per second, and the image is displayed in real time. As well, this technique allows imaging of aperiodic vibrations<sup id="cite_ref-:0_17-3" class="reference"><a href="#cite_note-:0-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> and can thus be used with patients presenting with all severities of dysphonia. </p> <div class="mw-heading mw-heading3"><h3 id="Acoustic_measures">Acoustic measures</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hoarse_voice&action=edit&section=9" title="Edit section: Acoustic measures"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Acoustic measures can be used to provide objective measures of vocal function. Signal processing <a href="/wiki/Algorithm" title="Algorithm">algorithms</a> are applied to voice recordings made during sustained <a href="/wiki/Phonation" title="Phonation">phonation</a> or during spontaneous speech.<sup id="cite_ref-:5_29-0" class="reference"><a href="#cite_note-:5-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> The acoustic parameters which can then be examined include <a href="/wiki/Fundamental_frequency" title="Fundamental frequency">fundamental frequency</a>, signal <a href="/wiki/Amplitude" title="Amplitude">amplitude</a>, jitter, shimmer, and noise-to-harmonic ratios.<sup id="cite_ref-:0_17-4" class="reference"><a href="#cite_note-:0-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> However, due to limitations imposed by the algorithms employed, these measures cannot be used with patients who exhibit severe dysphonia.<sup id="cite_ref-:5_29-1" class="reference"><a href="#cite_note-:5-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Aerodynamic_measures">Aerodynamic measures</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hoarse_voice&action=edit&section=10" title="Edit section: Aerodynamic measures"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Aerodynamics" title="Aerodynamics">Aerodynamic</a> measures of voice include measures of <a href="/wiki/Lung_volumes" title="Lung volumes">air volume</a>, air flow and sub glottal air pressure. The normal aerodynamic parameters of voice vary considerably among individuals, which leads to a large overlapping range of values between dysphonic and non-dysphonic patients. This limits the use of these measures as a diagnostic tool.<sup id="cite_ref-:0_17-5" class="reference"><a href="#cite_note-:0-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> Nonetheless, they are useful when used in adjunct with other voice assessment measures, or as a tool for monitoring therapeutic effects over time.<sup id="cite_ref-:3_27-1" class="reference"><a href="#cite_note-:3-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Prevention">Prevention</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hoarse_voice&action=edit&section=11" title="Edit section: Prevention"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Given that certain occupations are more at risk for developing dysphonia (e.g., teachers) research into prevention studies have been conducted.<sup id="cite_ref-:8_30-0" class="reference"><a href="#cite_note-:8-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> Research into the effectiveness of prevention strategies for dysphonia have yet to produce definitive results, however, research is still ongoing.<sup id="cite_ref-:32_9-1" class="reference"><a href="#cite_note-:32-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:8_30-1" class="reference"><a href="#cite_note-:8-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> Primarily, there are two types of vocal training recognized by professionals to help with prevention: direct and indirect. Direct prevention describes efforts to reduce conditions that may serve to increase vocal strain (such as patient education, relaxation strategies, etc.), while indirect prevention strategies refer to changes in the underlying physiological mechanism for voice production (e.g., adjustments to the manner in which vocal fold adduction occurs, respiratory training, shifting postural habits, etc.).<sup id="cite_ref-:32_9-2" class="reference"><a href="#cite_note-:32-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:8_30-2" class="reference"><a href="#cite_note-:8-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hoarse_voice&action=edit&section=12" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Although there is no universal classification of voice problems, voice disorders can be separated into certain categories: organic (structural or neurogenic), functional, neurological (psychogenic) or iatrogenic, for example.<sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> Depending on the diagnosis and severity of the voice problem, and depending on the category that the voice disorder falls into, there are various treatment methods that can be suggested to the patient. The professional has to keep in mind there is not one universal treatment, but rather the clinical approach must find what the optimal effective course of action for that particular patient is.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (November 2020)">citation needed</span></a></i>]</sup> </p><p>There are three main type of treatments: medical treatments, voice therapy and surgical treatments.<sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup> When necessary, certain voice disorders use a combination of treatment approaches.<sup id="cite_ref-:32_9-3" class="reference"><a href="#cite_note-:32-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> A medical treatment involves the use of botulinum toxin (botox) or anti-reflux medicines, for example. Botox is a key treatment for voice disorders such as Spasmodic Dysphonia.<sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> Voice therapy is mainly used with patients who have an underlying cause of voice misuse or abuse.<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> Laryngologists also recommend this type of treatment to patients who have an organic voice disorder - such as vocal fold nodules, cysts or polyps as well as to treat functional dysphonia.<sup id="cite_ref-:32_9-4" class="reference"><a href="#cite_note-:32-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Certain surgical treatments can be implemented as well - phono microsurgery (removal of vocal fold lesions performed with a microscope), laryngeal framework surgery (the manipulation of the voice box), as well as injection augmentation (injection of substance to vocal folds to improve closure). Surgical treatments may be recommended for patients having an organic dysphonia.<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> </p><p>A combination of both an indirect treatment method (an approach used to change external factors affecting the vocal folds)<sup id="cite_ref-:9_37-0" class="reference"><a href="#cite_note-:9-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> and a direct <a href="/wiki/Voice_therapy" title="Voice therapy">treatment</a> method (an approach used where the mechanisms functioning during the use of the vocal folds, such as phonation or respiration, are the main focus)<sup id="cite_ref-:9_37-1" class="reference"><a href="#cite_note-:9-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> may be used to treat dysphonia.<sup id="cite_ref-:32_9-5" class="reference"><a href="#cite_note-:32-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:02_12-1" class="reference"><a href="#cite_note-:02-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:42_38-0" class="reference"><a href="#cite_note-:42-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:1_39-0" class="reference"><a href="#cite_note-:1-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Direct_therapies">Direct therapies</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hoarse_voice&action=edit&section=13" title="Edit section: Direct therapies"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Direct therapies address the physical aspects of vocal production.<sup id="cite_ref-:32_9-6" class="reference"><a href="#cite_note-:32-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Techniques work to either modify vocal fold contact, manage breathing patterns, and/or change the tension at level of the larynx.<sup id="cite_ref-:32_9-7" class="reference"><a href="#cite_note-:32-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Notable techniques include, but are not limited to, the <a href="/w/index.php?title=Yawn-sigh_method&action=edit&redlink=1" class="new" title="Yawn-sigh method (page does not exist)">yawn-sigh method</a>, <a href="/w/index.php?title=Optimal_pitch&action=edit&redlink=1" class="new" title="Optimal pitch (page does not exist)">optimal pitch</a>, <a href="/w/index.php?title=Laryngeal_manipulation&action=edit&redlink=1" class="new" title="Laryngeal manipulation (page does not exist)">laryngeal manipulation</a>, humming, the <a href="/w/index.php?title=Accent_method&action=edit&redlink=1" class="new" title="Accent method (page does not exist)">accent method</a>, and the <a href="/wiki/Lee_Silverman_voice_treatment" title="Lee Silverman voice treatment">Lee Silverman Voice Treatment</a>.<sup id="cite_ref-:32_9-8" class="reference"><a href="#cite_note-:32-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:42_38-1" class="reference"><a href="#cite_note-:42-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> An example of a direct therapy is circumlaryngeal manual therapy, which has been used to reduce tension and massage hyoid-laryngeal muscles.<sup id="cite_ref-:02_12-2" class="reference"><a href="#cite_note-:02-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> This area is often tense from chronic elevation of the larynx.<sup id="cite_ref-:02_12-3" class="reference"><a href="#cite_note-:02-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Pressure is applied to these areas as the patient hums or sustains a vowel.<sup id="cite_ref-:02_12-4" class="reference"><a href="#cite_note-:02-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Traditional voice therapy is often used to treat muscular tension dysphonia.<sup id="cite_ref-:02_12-5" class="reference"><a href="#cite_note-:02-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Indirect_therapies">Indirect therapies</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hoarse_voice&action=edit&section=14" title="Edit section: Indirect therapies"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Indirect therapies take into account external factors that may influence vocal production.<sup id="cite_ref-:32_9-9" class="reference"><a href="#cite_note-:32-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> This incorporates maintenance of vocal hygiene practices, as well as the prevention of harmful vocal behaviours.<sup id="cite_ref-:52_40-0" class="reference"><a href="#cite_note-:52-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> Vocal hygiene includes adequate hydration of the vocal folds, monitoring the amount of voice use and rest, avoidance of vocal abuse (e.g., shouting, clearing of the throat), and taking into consideration lifestyle choices that may affect vocal health (e.g., smoking, sleeping habits).<sup id="cite_ref-:52_40-1" class="reference"><a href="#cite_note-:52-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> Vocal warm-ups and cool-downs may be employed to improve muscle tension and decrease risk of injury before strenuous vocal activities.<sup id="cite_ref-:52_40-2" class="reference"><a href="#cite_note-:52-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> It should be taken into account that vocal hygiene practices alone are minimally effective in treating dysphonia, and thus should be paired with other therapies.<sup id="cite_ref-:52_40-3" class="reference"><a href="#cite_note-:52-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Medication_and_surgery">Medication and surgery</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hoarse_voice&action=edit&section=15" title="Edit section: Medication and surgery"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Medical and surgical treatments have been recommended to treat organic dysphonias. An effective treatment for <a href="/wiki/Spasmodic_dysphonia" title="Spasmodic dysphonia">spasmodic dysphonia</a> (hoarseness resulting from periodic breaks in phonation due to hyperadduction of the vocal folds) is <a href="/wiki/Botulinum_toxin" title="Botulinum toxin">botulinum toxin</a> injection.<sup id="cite_ref-:2_8-1" class="reference"><a href="#cite_note-:2-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:6_41-0" class="reference"><a href="#cite_note-:6-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> The toxin acts by blocking <a href="/wiki/Acetylcholine" title="Acetylcholine">acetylcholine</a> release at the thyro-arytenoid muscle. Although the use of botulinum toxin injections is considered relatively safe, patients' responses to treatment differ in the initial stages; some have reported experiencing swallowing problems and breathy voice quality as a side-effect to the injections.<sup id="cite_ref-:2_8-2" class="reference"><a href="#cite_note-:2-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:6_41-1" class="reference"><a href="#cite_note-:6-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> Breathiness may last for a longer period of time for males than females.<sup id="cite_ref-:6_41-2" class="reference"><a href="#cite_note-:6-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> </p><p>Surgeries involve myoectomies of the laryngeal muscles to reduce voice breaks, and laryngoplasties, in which laryngeal cartilage is altered to reduce tension.<sup id="cite_ref-:2_8-3" class="reference"><a href="#cite_note-:2-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hoarse_voice&action=edit&section=16" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Dysphonia is a general term for voice impairment that is sometimes used synonymously with the <a href="/wiki/Perception" title="Perception">perceptual</a> voice quality of hoarseness.<sup id="cite_ref-:10_13-3" class="reference"><a href="#cite_note-:10-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> It is the reason for 1% of all visits to primary care providers.<sup id="cite_ref-:10_13-4" class="reference"><a href="#cite_note-:10-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> The <a href="/wiki/Prevalence" title="Prevalence">lifetime risk</a> of hoarse voice complaints among primary care patients is 30%.<sup id="cite_ref-:10_13-5" class="reference"><a href="#cite_note-:10-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Since hoarseness is a general symptom, it is associated with a number of laryngeal diagnoses.<sup id="cite_ref-:10_13-6" class="reference"><a href="#cite_note-:10-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p><p>There is an interplay of sex and age differences associated with dysphonia. The <a href="/wiki/Point_prevalence" class="mw-redirect" title="Point prevalence">point prevalence</a> of dysphonia in adults under the age of 65 is 6.6%.<sup id="cite_ref-:12_20-1" class="reference"><a href="#cite_note-:12-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Dysphonia is more common in adult females than males,<sup id="cite_ref-:12_20-2" class="reference"><a href="#cite_note-:12-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:13_42-0" class="reference"><a href="#cite_note-:13-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> possibly due to sex-related anatomical differences of the vocal mechanism.<sup id="cite_ref-cohen_4-1" class="reference"><a href="#cite_note-cohen-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> In childhood, however, dysphonia is more often found in boys than girls.<sup id="cite_ref-:11_43-0" class="reference"><a href="#cite_note-:11-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> As there are no anatomical differences in larynges of boys and girls prior to puberty, it has been proposed that the higher rate of voice impairment found in boys arises from louder social activities, personality factors, or more frequent inappropriate vocal use.<sup id="cite_ref-:11_43-1" class="reference"><a href="#cite_note-:11-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> The most common laryngeal diagnosis among children is <a href="/wiki/Vocal_cord_nodule" title="Vocal cord nodule">vocal fold nodules</a>,<sup id="cite_ref-:12_20-3" class="reference"><a href="#cite_note-:12-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> a condition known to be associated with vocally damaging behaviours.<sup id="cite_ref-44" class="reference"><a href="#cite_note-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> However, a causal relationship has not yet been definitively proven.<sup id="cite_ref-:11_43-2" class="reference"><a href="#cite_note-:11-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> The overall prevalence of dysphonia in children ranges from 3.9% - 23.4%, most commonly affecting children between the ages of 8 - 14.<sup id="cite_ref-:12_20-4" class="reference"><a href="#cite_note-:12-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Among the elderly, dysphonia is associated with both naturally occurring anatomical and physiological changes as well as higher rates of pathological conditions.<sup id="cite_ref-:13_42-1" class="reference"><a href="#cite_note-:13-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> The point prevalence of dysphonia among the elderly is 29%.<sup class="noprint Inline-Template" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Verifiability" title="Wikipedia:Verifiability"><span title="The material near this tag failed verification of its source citation(s). (March 2023)">failed verification</span></a></i>]</sup><sup id="cite_ref-:12_20-5" class="reference"><a href="#cite_note-:12-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Findings regarding the prevalence of geriatric dysphonia in the general population are very variable, ranging from 4 - 29.1%.<sup id="cite_ref-:13_42-2" class="reference"><a href="#cite_note-:13-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> This variability is likely due to different <a href="/wiki/Methodology" title="Methodology">methodology</a> used in obtaining information from participants.<sup id="cite_ref-:12_20-6" class="reference"><a href="#cite_note-:12-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> The most common laryngeal diagnoses among the elderly are polyps, <a href="/wiki/Laryngopharyngeal_reflux" title="Laryngopharyngeal reflux">laryngopharyngeal reflux</a>, muscle tension dysphonia, <a href="/wiki/Vocal_cord_paresis" title="Vocal cord paresis">vocal fold paresis</a> or <a href="/wiki/Paralysis_of_vocal_cords_and_larynx" class="mw-redirect" title="Paralysis of vocal cords and larynx">paralysis</a>, vocal fold mass, glottic insufficiency, <a href="/wiki/Malignant_lesion" class="mw-redirect" title="Malignant lesion">malignant lesions</a>, and neurologic conditions affecting the larynx.<sup id="cite_ref-:13_42-3" class="reference"><a href="#cite_note-:13-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Hoarse_voice&action=edit&section=17" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-1">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://dictionary.cambridge.org/dictionary/english/hoarseness">"Hoarseness"</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Hoarseness&rft_id=https%3A%2F%2Fdictionary.cambridge.org%2Fdictionary%2Fenglish%2Fhoarseness&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHoarse+voice" class="Z3988"></span></span> </li> <li id="cite_note-:03-2"><span class="mw-cite-backlink">^ <a href="#cite_ref-:03_2-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-:03_2-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-:03_2-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-:03_2-3"><sup><i><b>d</b></i></sup></a> <a href="#cite_ref-:03_2-4"><sup><i><b>e</b></i></sup></a> <a href="#cite_ref-:03_2-5"><sup><i><b>f</b></i></sup></a> <a href="#cite_ref-:03_2-6"><sup><i><b>g</b></i></sup></a> <a href="#cite_ref-:03_2-7"><sup><i><b>h</b></i></sup></a> <a href="#cite_ref-:03_2-8"><sup><i><b>i</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation news cs1"><a rel="nofollow" class="external text" href="https://www.nidcd.nih.gov/health/hoarseness">"Hoarseness"</a>. <i>NIDCD</i>. 2015-08-18<span class="reference-accessdate">. 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"Prevalence of voice disorders in the elderly: a systematic review of population-based studies". <i>European Archives of Oto-Rhino-Laryngology</i>. <b>272</b> (10): 2601–9. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1007%2Fs00405-014-3252-7">10.1007/s00405-014-3252-7</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/25149291">25149291</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:24668793">24668793</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=European+Archives+of+Oto-Rhino-Laryngology&rft.atitle=Prevalence+of+voice+disorders+in+the+elderly%3A+a+systematic+review+of+population-based+studies&rft.volume=272&rft.issue=10&rft.pages=2601-9&rft.date=2015-10&rft_id=https%3A%2F%2Fapi.semanticscholar.org%2FCorpusID%3A24668793%23id-name%3DS2CID&rft_id=info%3Apmid%2F25149291&rft_id=info%3Adoi%2F10.1007%2Fs00405-014-3252-7&rft.aulast=de+Ara%C3%BAjo+Pernambuco&rft.aufirst=L&rft.au=Espelt%2C+A&rft.au=Balata%2C+PM&rft.au=de+Lima%2C+KC&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHoarse+voice" class="Z3988"></span></span> </li> <li id="cite_note-:11-43"><span class="mw-cite-backlink">^ <a href="#cite_ref-:11_43-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-:11_43-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-:11_43-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMaiaGamaKümmer2014" class="citation journal cs1">Maia AA, Gama AC, Kümmer AM (April 2014). <a rel="nofollow" class="external text" href="https://doi.org/10.1590%2F2317-1782%2F2014408IN">"Behavioral characteristics of dysphonic children: integrative literature review"</a>. <i>CoDAS</i>. <b>26</b> (2): 159–63. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.1590%2F2317-1782%2F2014408IN">10.1590/2317-1782/2014408IN</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/24918510">24918510</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=CoDAS&rft.atitle=Behavioral+characteristics+of+dysphonic+children%3A+integrative+literature+review&rft.volume=26&rft.issue=2&rft.pages=159-63&rft.date=2014-04&rft_id=info%3Adoi%2F10.1590%2F2317-1782%2F2014408IN&rft_id=info%3Apmid%2F24918510&rft.aulast=Maia&rft.aufirst=AA&rft.au=Gama%2C+AC&rft.au=K%C3%BCmmer%2C+AM&rft_id=https%3A%2F%2Fdoi.org%2F10.1590%252F2317-1782%252F2014408IN&rfr_id=info%3Asid%2Fen.wikipedia.org%3AHoarse+voice" class="Z3988"></span></span> </li> <li id="cite_note-44"><span class="mw-cite-backlink"><b><a href="#cite_ref-44">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFMansuriTohidastSoltaninejadKamali2018" class="citation journal cs1">Mansuri B, Tohidast SA, Soltaninejad N, Kamali M, Ghelichi L, Azimi H (September 2018). "Nonmedical Treatments of Vocal Fold Nodules: A Systematic Review". <i>Journal of Voice</i>. <b>32</b> (5): 609–620. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1016%2Fj.jvoice.2017.08.023">10.1016/j.jvoice.2017.08.023</a>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/29032130">29032130</a>. <a href="/wiki/S2CID_(identifier)" class="mw-redirect" title="S2CID (identifier)">S2CID</a> <a rel="nofollow" class="external text" href="https://api.semanticscholar.org/CorpusID:37755681">37755681</a>.</cite><span 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style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q836379" class="extiw" title="d:Q836379">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/R49.0">R49.0</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=784.42">784.42</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D055154">D055154</a></li><li><b><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></b>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb28364.htm">28364</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/Patient_UK" title="Patient UK">Patient UK</a></b>: <a rel="nofollow" class="external text" href="https://patient.info/doctor/hoarseness-pro">Hoarse voice</a></li></ul></div></div></td></tr></tbody></table></div> <ul><li><a rel="nofollow" class="external text" href="http://www.asha.org/public/speech/disorders/voice/">ASHA: Voice Disorders</a></li> <li><a rel="nofollow" class="external text" href="http://www.asha.org/Practice-Portal/Clinical-Topics/Voice-Disorders/">ASHA: Clinical Topics - Voice Disorders Overview</a></li></ul> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Medicine" style="padding:3px"><table class="nowraplinks hlist mw-collapsible autocollapse navbox-inner" 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