Hoarseness is a word used to describe a change in voice quality ranging from voice harshness to voice weakness. Abnormality may lie any where along the vocal tract from the oral cavity to lungs. Ideally, it refers to laryngeal dysfunction caused by abnormal vocal cord vibration. In Ayurvedic texts, it is mentioned as Swarbhed Roga, which is caused by excessive and abnormal use of voice, due to toxins or external injury to larynx resulting in vitiation of dosha which produces the features according to their predominance. Hoarseness may be presented as one of the symptoms in certain other diseases as in tuberculosis, Cough and Coryza.

Speech is produced under three phases. 1st is pulmonary phase, which creates the energy flow with inflation and expulsion of air. This activity provides the larynx with a column of air for 2nd phase. 2nd phase is laryngeal phase in which vocal cords vibrate at certain frequency to create sound that is unique to the individual. Last phase is oral phase which occurs in the oral cavity where sound is modified. Words are formed by the action of pharynx, tongue, lips and teeth. Dysfunction in any of these stages can lead to voice change.

Hoarseness can be broken down into 2 broad categories - Acute onset & Chronic onset, acute onset is more common and is often caused by local inflammation of the larynx. It is seen in acute laryngitis due to viral, bacterial or fungal infections. Viral infections are most commonly responsible for laryngitis causing diffuse redness of the vocal cords and an increase in vocal cord mass. Laryngeal papillomatosis is a viral condition common in children inducing wart like growths on the vocal cords. It may be secondary to voice abuse, smoking and exposure to fumes. Main symptom is hoarseness with pain in throat.

Chronic Hoarseness is caused by benign polyps, vocal cord nodules, laryngeal tumours, contact granuloma, papilloma, neurological involvement, functional dysphonea, smoking and voice abuse. The patient complains of persistent altered voice which may become easily tired and patient has total loss of voice by the end of the day. A malignant process is considered if hoarseness has been progressive and present for several months, ultimately results in paralysis of vocal cords. This may be unilateral or bilateral. Thyroid cancers are the most common cause of bilateral vocal cords paralysis. Oesophageal and pulmonary cancers cause unilateral vocal cord paralysis. Vagus nerve, supplying the muscles of larynx may get injured after any neck procedure, corticothyroid joint injury or compression from an overinflated endotracheal cuff, causing hoarseness. Certain congenital laryngeal diseases are also responsible for hoarseness like laryngeal webs (net), cysts and congenital vocal cord paralysis.

Obstruction of venous drainage due to dilated pulmonary artery or aortic arch or obstruction of lymphatic drainage as in post radiation, increased capillary permeability to proteins as seen in rheumatoid arthritis, diabetes and hypothyroidism with myxodema are the conditions in which laryngeal oedema results in hoarseness. In Hysterical Aphonia, which is due to non organic cause of hoarseness, patient exhibits paradoxical motion of the vocal cords during speech. The vocal cords abduct and fail to vibrate adequately to produce sound but during quiet respiration or sleep, they work normally. The diagnosis can be made if a normal cough is present. Post nasal drip seen in chronic sinusitis and rhinitis, Gastro esophageal reflux, Intake of spicy food, singing etc. are the miscellaneous causes of hoarseness.

Management described in Ayurvedic texts is very effective in patients of hoarseness. Prime treatment is Nidaan Parivarjan means cessation of causative factors or avoidance of misuse and overuse of voice with treatment of vitiated dosha and dhatu. Following drugs are successfully used in cases of hoarseness.

Ayurvedic Powder Formulations useful for hoarseness are Madhuyashti Powder with honey and ghee, Trikatu Powder With cow urine, Triphala with honey and ghee, Vacha Powder with honey, Pippalyadi Powder & Ajmodadi Powder

From Aveleha (Pastes): Formulations Nidigdhikaveleha and Kalyanaveleha are most recommended for Hoarseness

From Ghrit Formulations: Kasmard Ghrit, Shunthi Ghrit and Vyaghri Ghrit

From Ayurvedic decoction: Formulations Tulsyadi Kashaya, Panchwalkal Kashaya & Dashmool Kashaya are very effective. Babooladi Kwath is used internally and for gargles locally. Fumigation with Haridra and Guggul are most effective in Hoarseness, for Nasya Anu Tail is used twice daily.

In acute conditions of hoarseness when pain and fever are associated features one must step to antibiotic, anti-inflammatory drugs. When the condition becomes chronic, not improving with drugs, surgical treatment must be considered after proper investigations. Speech therapist for residual speech must be consulted.

1. Lecturer, Deptt of Shalakya Tantra

2. H.O.D. Deptt. Of Shalakya Tantra

Dayanand Ayurvedic College,

Jalandhar-144008 (Pb.).