Dysphonia (Hoarseness): Causes, Diagnosis, and Treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Dysphonia, or hoarseness, is an alteration of the voice that can indicate a pathology of the vocal cords, laryngeal reflux, or laryngeal cancer. Causes, laryngoscopy, and treatment in Quebec.\">\n<meta name=\"keywords\" content=\"dysphonie enrouement causes, enrouement persistant, dysphonie laryngoscopie, nodules cordes vocales, cancer larynx enrouement, reflux laryngopharyng\u00e9 dysphonie, dysphonie traitement Qu\u00e9bec, voix enrou\u00e9e persistante\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n.co-wrap * { font-family: 'Poppins', sans-serif; box-sizing: border-box; }\n.co-wrap { max-width: 1100px; margin: 0 auto; padding: 30px 0 60px; }\n.co-label { font-family: 'Cinzel', serif; font-size: 14px; font-weight: bold; letter-spacing: 1px; text-transform: uppercase; color: #4D6577; margin-bottom: 14px; display: block; }\n.co-wrap h1 { font-size: 32px; font-weight: 500; color: #323C52; margin: 0 0 22px; line-height: 1.2; }\n.co-intro { font-size: 16px; line-height: 1.75; color: #4D6577; margin-bottom: 36px; padding-bottom: 32px; border-bottom: 1px solid rgba(77,101,119,.2); }\n.co-wrap h2 { font-size: 20px; font-weight: 600; color: #323C52; margin: 32px 0 12px; }\n.co-wrap p { font-size: 15px; color: #4D6577; line-height: 1.7; margin-bottom: 14px; }\n.co-list { list-style: none; padding: 0; margin: 12px 0 24px; }\n.co-list li { font-size: 15px; color: #4D6577; padding: 10px 14px 10px 38px; margin-bottom: 8px; border-radius: 6px; position: relative; background: rgba(77,101,119,.06); border-left: 3px solid #4D6577; }\n.co-list li::before { content: \"\u2713\"; position: absolute; left: 12px; font-weight: 700; color: #4D6577; }\n.co-table { width: 100%; border-collapse: collapse; margin: 14px 0 22px; font-size: 14px; border-radius: 8px; overflow: hidden; table-layout: fixed; }\n.co-table thead tr { background: #323C52; color: #fff; }\n.co-table thead th { padding: 11px 16px; text-align: left; font-weight: 600; font-size: 13px; }\n.co-table tbody tr:nth-child(even) { background: rgba(77,101,119,.06); }\n.co-table tbody tr:nth-child(odd) { background: #fff; }\n.co-table td { padding: 10px 16px; color: #4D6577; border-bottom: 1px solid rgba(77,101,119,.12); font-size: 14px; vertical-align: top; }\n.co-table td:first-child { font-weight: 600; color: #323C52; }\n.co-infobox { display: flex; gap: 12px; background: rgba(77,101,119,.06); border-radius: 8px; border-left: 4px solid #4D6577; padding: 14px 18px; margin: 18px 0 28px; font-size: 14px; color: #4D6577; line-height: 1.65; }\n.co-infobox .ico { font-size: 18px; flex-shrink: 0; }\n.co-urgence { background: #fff8f8; border-left: 5px solid #c0392b; border-radius: 6px; padding: 20px 26px; margin: 24px 0 32px; }\n.co-urgence .co-urgence-titre { font-size: 13px; font-weight: 700; color: #c0392b; letter-spacing: 1.5px; text-transform: uppercase; margin-bottom: 10px; }\n.co-urgence p { color: #5a2020; font-size: 14px; margin: 0 0 10px; line-height: 1.7; }\n.co-urgence p:last-child { margin-bottom: 0; }\n.co-disclaimer { font-size: 13px; color: #8a9aaa; font-style: italic; border-top: 1px solid rgba(77,101,119,.15); padding-top: 24px; margin-top: 40px; line-height: 1.6; }\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">Otolaryngology & Family Medicine & Head and Neck Surgery<\/span>\n <h1>Dysphonia (hoarseness)<\/h1>\n\n <div class=\"co-intro\">\n Dysphonia refers to any qualitative or quantitative alteration of the voice - change in timbre (hoarse, raspy, veiled, blown), pitch (abnormal low or high voice), intensity (dead voice, partial aphonia) or vocal endurance (rapid vocal fatigue) - compared to the person's usual voice. Hoarseness is the most frequent and recognizable manifestation. Voice production relies on the vibration of the vocal cords (vocal folds) as exhaled air passes through: any structural, inflammatory, neurological or functional lesion that alters the morphology, flexibility or mobility of the vocal cords can cause dysphonia. Dysphonia is an extremely frequent symptom in clinical practice - its instantaneous prevalence is estimated at 1 % of the general population, with a lifetime prevalence of 30 % - and is a major reason for consultation among voice professionals (teachers, singers, actors, lawyers, telephone operators), who represent around 25 % of the working population. The vast majority of acute dysphonias are benign and transient (viral or acute laryngitis - spontaneous resolution in 1-2 weeks). On the other hand, dysphonia persisting beyond 2-3 weeks with no obvious cause should systematically lead to laryngoscopy to visualize the vocal cords and rule out a neoplastic lesion (laryngeal cancer - of which squamous cell carcinoma is the main form): smoking is the major risk factor, and persistent dysphonia in a smoker is laryngeal cancer until proven otherwise. Laryngeal cancer accounts for 25-30 % of cancers of the upper aerodigestive tract (UADT) - 5,000 new cases\/year in Canada - with an excellent prognosis in the early stages (5-year survival >90 % for T1-T2) if detected early.\n <\/div>\n\n <h2>Causes of dysphonia - classification<\/h2>\n <table class=\"co-table\">\n <colgroup><col style=\"width:210px;\"><col style=\"width:42%;\"><col><\/colgroup>\n <thead>\n <tr><th>Cause<\/th><th>Mechanism and clinical presentation<\/th><th>Diagnosis and treatment<\/th><\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Acute viral laryngitis<br><small style=\"font-weight:400;color:#7a8fa0;\">Most frequent cause<\/small><\/td>\n <td>Upper respiratory viral infection (rhinovirus, adenovirus, influenza, RSV, SARS-CoV-2) \u2192 edema and inflammation of the laryngeal mucosa and vocal cords \u2192 thickening of the vocal folds \u2192 dysphonia or aphonia; context: flu-like syndrome or rhinopharyngitis in the preceding days; hoarse, raspy, painful voice with use; mild odynophagia; dry, irritative cough; usual duration: 7\u201314 days with spontaneous resolution<\/td>\n <td>Clinical Diagnosis \u2014 laryngoscopy not necessary if resolution in <3 weeks; Treatment: strict vocal rest (whispering worsens vocal cord strain \u2014 absolutely avoid); ample hydration (mucosal humidification); steam inhalations; avoid alcohol, tobacco, caffeine (mucosal drying); NSAIDs or paracetamol if odynophagia; corticosteroids (dexamethasone 10 mg IM single dose) if professional aphonia requiring rapid recovery \u2014 occasional use justified in voice professionals<\/td>\n <\/tr>\n <tr>\n <td>Laryngopharyngeal reflux (LPR)<br><small style=\"font-weight:400;color:#7a8fa0;\">Frequently unrecognized cause<\/small><\/td>\n <td>Acidic and\/or non-acidic gastric content reflux (pepsin, bile acids) up to the larynx and pharynx \u2192 chronic chemical irritation of the laryngeal mucosa \u2192 erythema of the arytenoids and laryngeal margin, subglottic edema (pseudomembrane) \u2192 chronic dysphonia + muffled voice in the morning + chronic throat clearing + nocturnal dry cough + pharyngeal globus (sensation of a foreign body in the throat); LPR can exist without pyrosis or regurgitation (60\u201370 % of cases) \u2014 which clinically distinguishes it from classic GERD; increasing incidence, likely favored by obesity and late meals<\/td>\n <td>Ambulatory high-resolution pH monitoring (with pharyngeal probe positioned at the level of the upper esophageal sphincter) \u2014 gold standard; RSI (Reflux Symptom Index >13 \u2014 suggestive); laryngoscopy (arytenoid erythema and edema, subglottic pseudomembrane); treatment: double-dose PPI (omeprazole 40 mg \u00d7 2\/day) for 3\u20136 months (response to treatment can itself confirm the diagnosis); lifestyle and dietary measures (elevate head of bed 15\u201320 cm, avoid meals 3 hours before bedtime, reduce alcohol, coffee, acidic foods); alginate antacids (Gaviscon) after meals and at bedtime<\/td>\n <\/tr>\n <tr>\n <td>Vocal cord nodules<br><small style=\"font-weight:400;color:#7a8fa0;\">Voice Professionals<\/small><\/td>\n <td>Bilateral symmetric benign lesions located at the junction of the anterior and middle thirds of the vocal folds (maximum vibration zone \u2013 nodal contact point) \u2192 result from repeated chronic vocal trauma (vocal abuse, poor vocal technique); high prevalence in teachers (30\u201340 %), professional singers, children (childhood nodules \u2013 \u00abscreamer's nodules\u00bb); hoarse, breathy voice with rapid vocal fatigue; symptoms worsen at the end of the day after intensive vocal use; nodules are generally bilateral (unlike polyps, which are unilateral)<\/td>\n <td>Laryngoscopy with laryngeal stroboscopy (visualization of bilateral nodules + mucosal wave analysis) - gold standard exam; treatment: speech therapy (first-line treatment - correction of poor vocal technique + vocal hygiene + voice exercises); 80-90% success % with compliance; microlaryngosurgery (suspension microsurgery under general anesthesia - nodule resection with CO2 laser or microinstruments) if speech therapy failure \u22656 months or fixed fibrous lesions; relative vocal rest (not strict - counterproductive to speech therapy training)<\/td>\n <\/tr>\n <tr>\n <td>Vocal cord polyp<\/td>\n <td>Benign lesion, most often unilateral (unlike nodules) - pedunculated or sessile - resulting from an episode of acute vocal strain or scarred intracordal hemorrhage; chronic hoarse voice, sometimes with vocal diplopia (two simultaneous sounds); the polyp can become secondarily infected (ulcerated polyp); risk factors: smoking, intense sudden vocal effort (shouting, coughing) on fragile mucosa<\/td>\n <td>Laryngoscopy with stroboscopy (pedunculated unilateral polyp visible); standard surgical treatment (laryngeal microsurgery \u2014 resection with microinstruments or CO2 laser) \u2014 indispensable postoperative speech therapy (prevention of recurrence); mandatory smoking cessation<\/td>\n <\/tr>\n <tr>\n <td>Laryngeal cancer<br><small style=\"font-weight:400;color:#7a8fa0;\">Absolute red flag \u2014 smoker >2-3 weeks<\/small><\/td>\n <td>Carcinome \u00e9pidermo\u00efde (95 % des cas) \u2014 les formes glottiques (cordes vocales) sont les plus fr\u00e9quentes (60\u201365 %) et les plus pr\u00e9cocement symptomatiques (dysphonie d\u00e8s le stade T1) ; les formes supraglottiques (\u00e9piglotte, bandes ventriculaires) et sous-glottiques sont souvent diagnostiqu\u00e9es plus tardivement (dysphagie, ad\u00e9nopathie cervicale) ; facteurs de risque : tabagisme (\u00d710\u201315 risque) + alcool (effet synergique multiplicateur) + HPV 16\/18 (surtout supraglottique) ; voix rauque progressive, persistante, ne s'am\u00e9liorant pas ; odynophagie, dysphagie, otalgie r\u00e9flexe (douleur irradiant dans l'oreille), stridor (stade avanc\u00e9), ad\u00e9nopathie cervicale ; h\u00e9moptysie (rare)<\/td>\n <td>Indirect laryngoscopy (laryngeal mirror or flexible nasofiberscopy) \u2192 direct laryngoscopy under general anesthesia with multiple biopsies \u2014 diagnostic gold standard; cervicothoracic CT scan with contrast (local extension, adenopathy, pulmonary metastases) + FDG-PET scan if advanced stage; treatment: T1\u2013T2 glottic \u2014 exclusive radiotherapy (70 Gy over 7 weeks) or conservative surgery (transglottic endoscopic CO2 laser cordectomy) \u2014 5-year survival >90 %; T3\u2013T4 \u2014 total laryngectomy \u00b1 cervical lymph node dissection \u00b1 adjuvant chemoradiotherapy (cisplatin + 5-FU); laryngeal preservation protocols (induction chemo + RT) if possible<\/td>\n <\/tr>\n <tr>\n <td>Recurrent laryngeal paralysis<br><small style=\"font-weight:400;color:#7a8fa0;\">Vocal cord immobility<\/small><\/td>\n <td>Recurrent laryngeal nerve lesion (branch of vagus nerve X) \u2192 vocal cord immobility in paramedian or lateral position \u2192 breathy orDiplophonia, aphonia, dysphagia (aspiration); causes: thyroid or parathyroid surgery (per-operative lesion \u2014 1\u20133 % after total thyroidectomy); left apical lung cancer (left recurrent laryngeal nerve loops around aortic arch \u2014 left apical tumor compresses nerve); aortic aneurysm; mediastinal tumor; idiopathic (viral \u2014 spontaneous recovery in 60\u201370 % at 12 months); carotid dissection<\/td>\n <td>Laryngoscopy (visualization of vocal cord immobility); cervicothoracic CT scan (search for a compressive cause \u2014 pulmonary tumor, aortic aneurysm, mediastinal adenopathy) \u00b1 cervicomedial MRI; laryngeal EMG (prognosis for recovery); treatment: if idiopathic or post-viral paralysis \u2014 speech therapy + expectant management for 12 months (60\u201370% spontaneous recovery %); if persistence \u2014 medialization thyroplasty (Silastic implant to approximate the paralyzed cord) or intracordal injection (fat, calcium hydroxyapatite \u2014 Radiesse Voice); treatment of the cause if identifiable<\/td>\n <\/tr>\n <tr>\n <td>Functional (psychogenic) dysphonia<\/td>\n <td>Voice alteration without identifiable organic lesion of the vocal cords \u2014 laryngoscopy shows normal vocal cords or incomplete functional glottic closure; mechanisms: excessive laryngeal muscle tension (muscle tension dysphonia \u2014 MTD); psychogenic conversion (sudden complete aphonia often triggered by emotional stress \u2014 vocal cords close on swallowing but not on phonation); persistent falsetto voice in adolescent males (puberphonia \u2014 unconscious refusal to adopt the post-pubertal deep voice); vocal anxiety in voice professionals (stage fright)<\/td>\n <td>Normal laryngoscopy (or functional spasm) \u2014 diagnosis of exclusion after ruling out organic causes; treatment: specialized vocal speech therapy (re-education of posture, breathing, laryngeal muscle tension \u2014 excellent results in MTD); psychological support if anxiety or trauma component; external laryngeal massage (reduction of peri-laryngeal muscle tension); puberphonia is treated in one to two speech therapy sessions in 95 % of cases<\/td>\n <\/tr>\n <tr>\n <td>Other causes<\/td>\n <td>Hypothyroidism (laryngeal myxedema \u2014 hoarse, deep voice); acromegaly (macroglossia + vocal cord thickening); laryngeal amyloidosis (vocal cord infiltration); recurrent laryngeal papillomatosis (HPV 6\/11 \u2014 multiple proliferative benign lesions \u2014 repeated laser treatment \u2014 risk of malignant transformation <1 %); post-intubation granuloma (arytenoid trauma during oro-tracheal intubation); tobacco alone without cancer (chronic laryngitis + Reinke's edema \u2014 gelatinous filling of the subepithelial stroma of the vocal cords \u2014 very deep voice, especially in female smokers)<\/td>\n <td>TSH + free T4 (hypothyroidism); IGF-1 + GH (acromegaly); laryngeal biopsy (amyloidosis, papillomatosis\u2014HPV typing); laryngoscopy post-extubation if dysphonia after prolonged intubation; microlaryngeal surgery if symptomatic Reinke's edema (after smoking cessation\u2014essential)<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Red Flags \u2013 Indications for Urgent Laryngoscopy<\/h2>\n <ul class=\"co-list\">\n <li>Persistent dysphonia beyond 2-3 weeks without an obvious cause, especially in a smoker or former smoker \u2014 laryngoscopy is mandatory to rule out squamous cell carcinoma of the glottis (laryngeal cancer): early treatment of stage T1 disease \u2192 5-year survival >90% %<\/li>\n <li>Dysphonia associated with progressive dysphagia, odynophagia, unilateral otalgia (referred ear pain), or hemoptysis \u2014 supraglottic extension or location to be excluded<\/li>\n <li>Firm, painless cervical adenopathy appearing in a smoker with dysphonia \u2014 cervical lymph node metastasis from a head and neck squamous cell carcinoma until proven otherwise<\/li>\n <li>Inspiratory stridor accompanying dysphonia\u2014partial laryngeal obstruction requiring urgent evaluation (foreign body, epiglottitis, hematoma, obstructive tumor)<\/li>\n <li>Biphasic voice (vocal diplopia) of sudden onset - acute recurrent paralysis - emergency cervicothoracic CT scan to search for recurrent laryngeal nerve compression (lung cancer, aortic aneurysm)<\/li>\n <li>Post-thyroidectomy or cervical surgery dysphonia \u2014 systematic laryngoscopy within 48\u201372 hours postoperatively to document vocal cord mobility (legal reference) and guide early management<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span>Visit <strong>Voice professionals<\/strong> (teachers, singers, actors, lawyers, speakers) constitute a high-risk population for benign vocal fold pathologies (nodules, polyps, muscle tension dysphonia) due to intensive and repetitive vocal use. A <strong>Vocal hygiene<\/strong> Strict adherence is fundamental for preventing these lesions: abundant hydration (2 L of water\/day), avoiding whispering (higher vocal tension than normal speech), vocal rest after overuse, humidifying the ambient air in winter, avoiding repeated coughing and throat clearing, and limiting alcohol and coffee. Preventive speech therapy is recommended for voice professionals before the onset of symptoms, especially at the beginning of their careers.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Laryngeal emergencies<\/div>\n <p>Dial <strong>911<\/strong> immediately in case of: <strong>stridor<\/strong> (high-pitched inspiratory wheezing) + dysphonia + respiratory distress \u2014 partial or complete laryngeal obstruction (foreign body, acute H. influenzae epiglottitis, laryngeal angioedema, post-traumatic laryngeal hematoma) - risk of asphyxia; ; <strong>acute epiglottitis<\/strong> In children or adults: high fever + severe odynophagia + hypersalivation + dysphonia + tripod position (sitting, leaning forward) \u2014 life-threatening emergency \u2014 do not examine the throat (risk of laryngeal spasm) \u2014 possible emergency intubation or tracheotomy.<\/p>\n <p>See your doctor without delay if a <strong>Brutal, two-toned dysphonia<\/strong> appears after cervical or thyroid surgery \u2014 perioperative recurrent paralysis \u2014 ENT evaluation within 48 hours.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron physicians evaluate patients with dysphonia, prescribe first-line investigations (indirect laryngoscopy, TSH, reflux assessment), refer to ENT for nasofibroscopy and direct laryngoscopy if indicated, and coordinate speech therapy for benign vocal cord pathologies. Any dysphonia persisting beyond 3 weeks in a smoker is treated as a priority with rapid ENT referral. Consultations are available at our service points in Quebec as well as via telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is provided for informational purposes only and does not substitute for the advice of a qualified healthcare professional. Any hoarseness lasting more than 2\u20133 weeks should be evaluated by a doctor, particularly in smokers.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Dysphonie (enrouement) : causes, diagnostic et traitement | Clinique Omicron Oto-rhino-laryngologie & M\u00e9decine de famille & Chirurgie cervico-faciale Dysphonie (enrouement) La dysphonie d\u00e9signe toute alt\u00e9ration qualitative ou quantitative de la voix \u2014 modification du timbre (voix rauque, \u00e9raill\u00e9e, voil\u00e9e, souffl\u00e9e), de la hauteur (voix grave ou aigu\u00eb anormale), de l’intensit\u00e9 (voix \u00e9teinte, aphonie partielle) ou… <a href=\"https:\/\/cliniqueomicron.ca\/en\/dysphonie\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Dysphonia (Hoarseness): Causes, Diagnosis, and Treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Dysphonie (enrouement) : Diagnostic et traitement | Brossard | Clinique Omicron","_metasync_otto_description":"La dysphonie ou enrouement est une alt\u00e9ration de la voix pouvant indiquer une pathologie des cordes vocales, un reflux laryng\u00e9 ou un cancer du larynx. 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\n\t\t\t\t\t\n\n\n\n\nDysphonia (Hoarseness): Causes, Diagnosis, and Treatment | Clinique Omicron<\/title>\n<meta name=\"description\" content=\"Dysphonia, or hoarseness, is an alteration of the voice that can indicate a pathology of the vocal cords, laryngeal reflux, or laryngeal cancer. Causes, laryngoscopy, and treatment in Quebec.\">\n<meta name=\"keywords\" content=\"dysphonie enrouement causes, enrouement persistant, dysphonie laryngoscopie, nodules cordes vocales, cancer larynx enrouement, reflux laryngopharyng\u00e9 dysphonie, dysphonie traitement Qu\u00e9bec, voix enrou\u00e9e persistante\">\n<link rel=\"preconnect\" href=\"https:\/\/fonts.googleapis.com\">\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Cinzel:wght@600&family=Poppins:wght@400;500;600;700&display=swap\" rel=\"stylesheet\">\n<style>\n.co-wrap * { font-family: 'Poppins', sans-serif; box-sizing: border-box; }\n.co-wrap { max-width: 1100px; margin: 0 auto; padding: 30px 0 60px; }\n.co-label { font-family: 'Cinzel', serif; font-size: 14px; font-weight: bold; letter-spacing: 1px; text-transform: uppercase; color: #4D6577; margin-bottom: 14px; display: block; }\n.co-wrap h1 { font-size: 32px; font-weight: 500; color: #323C52; margin: 0 0 22px; line-height: 1.2; }\n.co-intro { font-size: 16px; line-height: 1.75; color: #4D6577; margin-bottom: 36px; padding-bottom: 32px; border-bottom: 1px solid rgba(77,101,119,.2); }\n.co-wrap h2 { font-size: 20px; font-weight: 600; color: #323C52; margin: 32px 0 12px; }\n.co-wrap p { font-size: 15px; color: #4D6577; line-height: 1.7; margin-bottom: 14px; }\n.co-list { list-style: none; padding: 0; margin: 12px 0 24px; }\n.co-list li { font-size: 15px; color: #4D6577; padding: 10px 14px 10px 38px; margin-bottom: 8px; border-radius: 6px; position: relative; background: rgba(77,101,119,.06); border-left: 3px solid #4D6577; }\n.co-list li::before { content: \"\u2713\"; position: absolute; left: 12px; font-weight: 700; color: #4D6577; }\n.co-table { width: 100%; border-collapse: collapse; margin: 14px 0 22px; font-size: 14px; border-radius: 8px; overflow: hidden; table-layout: fixed; }\n.co-table thead tr { background: #323C52; color: #fff; }\n.co-table thead th { padding: 11px 16px; text-align: left; font-weight: 600; font-size: 13px; }\n.co-table tbody tr:nth-child(even) { background: rgba(77,101,119,.06); }\n.co-table tbody tr:nth-child(odd) { background: #fff; }\n.co-table td { padding: 10px 16px; color: #4D6577; border-bottom: 1px solid rgba(77,101,119,.12); font-size: 14px; vertical-align: top; }\n.co-table td:first-child { font-weight: 600; color: #323C52; }\n.co-infobox { display: flex; gap: 12px; background: rgba(77,101,119,.06); border-radius: 8px; border-left: 4px solid #4D6577; padding: 14px 18px; margin: 18px 0 28px; font-size: 14px; color: #4D6577; line-height: 1.65; }\n.co-infobox .ico { font-size: 18px; flex-shrink: 0; }\n.co-urgence { background: #fff8f8; border-left: 5px solid #c0392b; border-radius: 6px; padding: 20px 26px; margin: 24px 0 32px; }\n.co-urgence .co-urgence-titre { font-size: 13px; font-weight: 700; color: #c0392b; letter-spacing: 1.5px; text-transform: uppercase; margin-bottom: 10px; }\n.co-urgence p { color: #5a2020; font-size: 14px; margin: 0 0 10px; line-height: 1.7; }\n.co-urgence p:last-child { margin-bottom: 0; }\n.co-disclaimer { font-size: 13px; color: #8a9aaa; font-style: italic; border-top: 1px solid rgba(77,101,119,.15); padding-top: 24px; margin-top: 40px; line-height: 1.6; }\n<\/style>\n<\/head>\n<body>\n<div class=\"co-wrap\">\n <span class=\"co-label\">Otolaryngology & Family Medicine & Head and Neck Surgery<\/span>\n <h1>Dysphonia (hoarseness)<\/h1>\n\n <div class=\"co-intro\">\n Dysphonia refers to any qualitative or quantitative alteration of the voice - change in timbre (hoarse, raspy, veiled, blown), pitch (abnormal low or high voice), intensity (dead voice, partial aphonia) or vocal endurance (rapid vocal fatigue) - compared to the person's usual voice. Hoarseness is the most frequent and recognizable manifestation. Voice production relies on the vibration of the vocal cords (vocal folds) as exhaled air passes through: any structural, inflammatory, neurological or functional lesion that alters the morphology, flexibility or mobility of the vocal cords can cause dysphonia. Dysphonia is an extremely frequent symptom in clinical practice - its instantaneous prevalence is estimated at 1 % of the general population, with a lifetime prevalence of 30 % - and is a major reason for consultation among voice professionals (teachers, singers, actors, lawyers, telephone operators), who represent around 25 % of the working population. The vast majority of acute dysphonias are benign and transient (viral or acute laryngitis - spontaneous resolution in 1-2 weeks). On the other hand, dysphonia persisting beyond 2-3 weeks with no obvious cause should systematically lead to laryngoscopy to visualize the vocal cords and rule out a neoplastic lesion (laryngeal cancer - of which squamous cell carcinoma is the main form): smoking is the major risk factor, and persistent dysphonia in a smoker is laryngeal cancer until proven otherwise. Laryngeal cancer accounts for 25-30 % of cancers of the upper aerodigestive tract (UADT) - 5,000 new cases\/year in Canada - with an excellent prognosis in the early stages (5-year survival >90 % for T1-T2) if detected early.\n <\/div>\n\n <h2>Causes of dysphonia - classification<\/h2>\n <table class=\"co-table\">\n <colgroup><col style=\"width:210px;\"><col style=\"width:42%;\"><col><\/colgroup>\n <thead>\n <tr><th>Cause<\/th><th>Mechanism and clinical presentation<\/th><th>Diagnosis and treatment<\/th><\/tr>\n <\/thead>\n <tbody>\n <tr>\n <td>Acute viral laryngitis<br><small style=\"font-weight:400;color:#7a8fa0;\">Most frequent cause<\/small><\/td>\n <td>Upper respiratory viral infection (rhinovirus, adenovirus, influenza, RSV, SARS-CoV-2) \u2192 edema and inflammation of the laryngeal mucosa and vocal cords \u2192 thickening of the vocal folds \u2192 dysphonia or aphonia; context: flu-like syndrome or rhinopharyngitis in the preceding days; hoarse, raspy, painful voice with use; mild odynophagia; dry, irritative cough; usual duration: 7\u201314 days with spontaneous resolution<\/td>\n <td>Clinical Diagnosis \u2014 laryngoscopy not necessary if resolution in <3 weeks; Treatment: strict vocal rest (whispering worsens vocal cord strain \u2014 absolutely avoid); ample hydration (mucosal humidification); steam inhalations; avoid alcohol, tobacco, caffeine (mucosal drying); NSAIDs or paracetamol if odynophagia; corticosteroids (dexamethasone 10 mg IM single dose) if professional aphonia requiring rapid recovery \u2014 occasional use justified in voice professionals<\/td>\n <\/tr>\n <tr>\n <td>Laryngopharyngeal reflux (LPR)<br><small style=\"font-weight:400;color:#7a8fa0;\">Frequently unrecognized cause<\/small><\/td>\n <td>Acidic and\/or non-acidic gastric content reflux (pepsin, bile acids) up to the larynx and pharynx \u2192 chronic chemical irritation of the laryngeal mucosa \u2192 erythema of the arytenoids and laryngeal margin, subglottic edema (pseudomembrane) \u2192 chronic dysphonia + muffled voice in the morning + chronic throat clearing + nocturnal dry cough + pharyngeal globus (sensation of a foreign body in the throat); LPR can exist without pyrosis or regurgitation (60\u201370 % of cases) \u2014 which clinically distinguishes it from classic GERD; increasing incidence, likely favored by obesity and late meals<\/td>\n <td>Ambulatory high-resolution pH monitoring (with pharyngeal probe positioned at the level of the upper esophageal sphincter) \u2014 gold standard; RSI (Reflux Symptom Index >13 \u2014 suggestive); laryngoscopy (arytenoid erythema and edema, subglottic pseudomembrane); treatment: double-dose PPI (omeprazole 40 mg \u00d7 2\/day) for 3\u20136 months (response to treatment can itself confirm the diagnosis); lifestyle and dietary measures (elevate head of bed 15\u201320 cm, avoid meals 3 hours before bedtime, reduce alcohol, coffee, acidic foods); alginate antacids (Gaviscon) after meals and at bedtime<\/td>\n <\/tr>\n <tr>\n <td>Vocal cord nodules<br><small style=\"font-weight:400;color:#7a8fa0;\">Voice Professionals<\/small><\/td>\n <td>Bilateral symmetric benign lesions located at the junction of the anterior and middle thirds of the vocal folds (maximum vibration zone \u2013 nodal contact point) \u2192 result from repeated chronic vocal trauma (vocal abuse, poor vocal technique); high prevalence in teachers (30\u201340 %), professional singers, children (childhood nodules \u2013 \u00abscreamer's nodules\u00bb); hoarse, breathy voice with rapid vocal fatigue; symptoms worsen at the end of the day after intensive vocal use; nodules are generally bilateral (unlike polyps, which are unilateral)<\/td>\n <td>Laryngoscopy with laryngeal stroboscopy (visualization of bilateral nodules + mucosal wave analysis) - gold standard exam; treatment: speech therapy (first-line treatment - correction of poor vocal technique + vocal hygiene + voice exercises); 80-90% success % with compliance; microlaryngosurgery (suspension microsurgery under general anesthesia - nodule resection with CO2 laser or microinstruments) if speech therapy failure \u22656 months or fixed fibrous lesions; relative vocal rest (not strict - counterproductive to speech therapy training)<\/td>\n <\/tr>\n <tr>\n <td>Vocal cord polyp<\/td>\n <td>Benign lesion, most often unilateral (unlike nodules) - pedunculated or sessile - resulting from an episode of acute vocal strain or scarred intracordal hemorrhage; chronic hoarse voice, sometimes with vocal diplopia (two simultaneous sounds); the polyp can become secondarily infected (ulcerated polyp); risk factors: smoking, intense sudden vocal effort (shouting, coughing) on fragile mucosa<\/td>\n <td>Laryngoscopy with stroboscopy (pedunculated unilateral polyp visible); standard surgical treatment (laryngeal microsurgery \u2014 resection with microinstruments or CO2 laser) \u2014 indispensable postoperative speech therapy (prevention of recurrence); mandatory smoking cessation<\/td>\n <\/tr>\n <tr>\n <td>Laryngeal cancer<br><small style=\"font-weight:400;color:#7a8fa0;\">Absolute red flag \u2014 smoker >2-3 weeks<\/small><\/td>\n <td>Carcinome \u00e9pidermo\u00efde (95 % des cas) \u2014 les formes glottiques (cordes vocales) sont les plus fr\u00e9quentes (60\u201365 %) et les plus pr\u00e9cocement symptomatiques (dysphonie d\u00e8s le stade T1) ; les formes supraglottiques (\u00e9piglotte, bandes ventriculaires) et sous-glottiques sont souvent diagnostiqu\u00e9es plus tardivement (dysphagie, ad\u00e9nopathie cervicale) ; facteurs de risque : tabagisme (\u00d710\u201315 risque) + alcool (effet synergique multiplicateur) + HPV 16\/18 (surtout supraglottique) ; voix rauque progressive, persistante, ne s'am\u00e9liorant pas ; odynophagie, dysphagie, otalgie r\u00e9flexe (douleur irradiant dans l'oreille), stridor (stade avanc\u00e9), ad\u00e9nopathie cervicale ; h\u00e9moptysie (rare)<\/td>\n <td>Indirect laryngoscopy (laryngeal mirror or flexible nasofiberscopy) \u2192 direct laryngoscopy under general anesthesia with multiple biopsies \u2014 diagnostic gold standard; cervicothoracic CT scan with contrast (local extension, adenopathy, pulmonary metastases) + FDG-PET scan if advanced stage; treatment: T1\u2013T2 glottic \u2014 exclusive radiotherapy (70 Gy over 7 weeks) or conservative surgery (transglottic endoscopic CO2 laser cordectomy) \u2014 5-year survival >90 %; T3\u2013T4 \u2014 total laryngectomy \u00b1 cervical lymph node dissection \u00b1 adjuvant chemoradiotherapy (cisplatin + 5-FU); laryngeal preservation protocols (induction chemo + RT) if possible<\/td>\n <\/tr>\n <tr>\n <td>Recurrent laryngeal paralysis<br><small style=\"font-weight:400;color:#7a8fa0;\">Vocal cord immobility<\/small><\/td>\n <td>Recurrent laryngeal nerve lesion (branch of vagus nerve X) \u2192 vocal cord immobility in paramedian or lateral position \u2192 breathy orDiplophonia, aphonia, dysphagia (aspiration); causes: thyroid or parathyroid surgery (per-operative lesion \u2014 1\u20133 % after total thyroidectomy); left apical lung cancer (left recurrent laryngeal nerve loops around aortic arch \u2014 left apical tumor compresses nerve); aortic aneurysm; mediastinal tumor; idiopathic (viral \u2014 spontaneous recovery in 60\u201370 % at 12 months); carotid dissection<\/td>\n <td>Laryngoscopy (visualization of vocal cord immobility); cervicothoracic CT scan (search for a compressive cause \u2014 pulmonary tumor, aortic aneurysm, mediastinal adenopathy) \u00b1 cervicomedial MRI; laryngeal EMG (prognosis for recovery); treatment: if idiopathic or post-viral paralysis \u2014 speech therapy + expectant management for 12 months (60\u201370% spontaneous recovery %); if persistence \u2014 medialization thyroplasty (Silastic implant to approximate the paralyzed cord) or intracordal injection (fat, calcium hydroxyapatite \u2014 Radiesse Voice); treatment of the cause if identifiable<\/td>\n <\/tr>\n <tr>\n <td>Functional (psychogenic) dysphonia<\/td>\n <td>Voice alteration without identifiable organic lesion of the vocal cords \u2014 laryngoscopy shows normal vocal cords or incomplete functional glottic closure; mechanisms: excessive laryngeal muscle tension (muscle tension dysphonia \u2014 MTD); psychogenic conversion (sudden complete aphonia often triggered by emotional stress \u2014 vocal cords close on swallowing but not on phonation); persistent falsetto voice in adolescent males (puberphonia \u2014 unconscious refusal to adopt the post-pubertal deep voice); vocal anxiety in voice professionals (stage fright)<\/td>\n <td>Normal laryngoscopy (or functional spasm) \u2014 diagnosis of exclusion after ruling out organic causes; treatment: specialized vocal speech therapy (re-education of posture, breathing, laryngeal muscle tension \u2014 excellent results in MTD); psychological support if anxiety or trauma component; external laryngeal massage (reduction of peri-laryngeal muscle tension); puberphonia is treated in one to two speech therapy sessions in 95 % of cases<\/td>\n <\/tr>\n <tr>\n <td>Other causes<\/td>\n <td>Hypothyroidism (laryngeal myxedema \u2014 hoarse, deep voice); acromegaly (macroglossia + vocal cord thickening); laryngeal amyloidosis (vocal cord infiltration); recurrent laryngeal papillomatosis (HPV 6\/11 \u2014 multiple proliferative benign lesions \u2014 repeated laser treatment \u2014 risk of malignant transformation <1 %); post-intubation granuloma (arytenoid trauma during oro-tracheal intubation); tobacco alone without cancer (chronic laryngitis + Reinke's edema \u2014 gelatinous filling of the subepithelial stroma of the vocal cords \u2014 very deep voice, especially in female smokers)<\/td>\n <td>TSH + free T4 (hypothyroidism); IGF-1 + GH (acromegaly); laryngeal biopsy (amyloidosis, papillomatosis\u2014HPV typing); laryngoscopy post-extubation if dysphonia after prolonged intubation; microlaryngeal surgery if symptomatic Reinke's edema (after smoking cessation\u2014essential)<\/td>\n <\/tr>\n <\/tbody>\n <\/table>\n\n <h2>Red Flags \u2013 Indications for Urgent Laryngoscopy<\/h2>\n <ul class=\"co-list\">\n <li>Persistent dysphonia beyond 2-3 weeks without an obvious cause, especially in a smoker or former smoker \u2014 laryngoscopy is mandatory to rule out squamous cell carcinoma of the glottis (laryngeal cancer): early treatment of stage T1 disease \u2192 5-year survival >90% %<\/li>\n <li>Dysphonia associated with progressive dysphagia, odynophagia, unilateral otalgia (referred ear pain), or hemoptysis \u2014 supraglottic extension or location to be excluded<\/li>\n <li>Firm, painless cervical adenopathy appearing in a smoker with dysphonia \u2014 cervical lymph node metastasis from a head and neck squamous cell carcinoma until proven otherwise<\/li>\n <li>Inspiratory stridor accompanying dysphonia\u2014partial laryngeal obstruction requiring urgent evaluation (foreign body, epiglottitis, hematoma, obstructive tumor)<\/li>\n <li>Biphasic voice (vocal diplopia) of sudden onset - acute recurrent paralysis - emergency cervicothoracic CT scan to search for recurrent laryngeal nerve compression (lung cancer, aortic aneurysm)<\/li>\n <li>Post-thyroidectomy or cervical surgery dysphonia \u2014 systematic laryngoscopy within 48\u201372 hours postoperatively to document vocal cord mobility (legal reference) and guide early management<\/li>\n <\/ul>\n\n <div class=\"co-infobox\">\n <span class=\"ico\">\u2139\ufe0f<\/span>\n <span>Visit <strong>Voice professionals<\/strong> (teachers, singers, actors, lawyers, speakers) constitute a high-risk population for benign vocal fold pathologies (nodules, polyps, muscle tension dysphonia) due to intensive and repetitive vocal use. A <strong>Vocal hygiene<\/strong> Strict adherence is fundamental for preventing these lesions: abundant hydration (2 L of water\/day), avoiding whispering (higher vocal tension than normal speech), vocal rest after overuse, humidifying the ambient air in winter, avoiding repeated coughing and throat clearing, and limiting alcohol and coffee. Preventive speech therapy is recommended for voice professionals before the onset of symptoms, especially at the beginning of their careers.<\/span>\n <\/div>\n\n <div class=\"co-urgence\">\n <div class=\"co-urgence-titre\">Laryngeal emergencies<\/div>\n <p>Dial <strong>911<\/strong> immediately in case of: <strong>stridor<\/strong> (high-pitched inspiratory wheezing) + dysphonia + respiratory distress \u2014 partial or complete laryngeal obstruction (foreign body, acute H. influenzae epiglottitis, laryngeal angioedema, post-traumatic laryngeal hematoma) - risk of asphyxia; ; <strong>acute epiglottitis<\/strong> In children or adults: high fever + severe odynophagia + hypersalivation + dysphonia + tripod position (sitting, leaning forward) \u2014 life-threatening emergency \u2014 do not examine the throat (risk of laryngeal spasm) \u2014 possible emergency intubation or tracheotomy.<\/p>\n <p>See your doctor without delay if a <strong>Brutal, two-toned dysphonia<\/strong> appears after cervical or thyroid surgery \u2014 perioperative recurrent paralysis \u2014 ENT evaluation within 48 hours.<\/p>\n <\/div>\n\n <h2>Consult at Clinique Omicron<\/h2>\n <p>Clinique Omicron physicians evaluate patients with dysphonia, prescribe first-line investigations (indirect laryngoscopy, TSH, reflux assessment), refer to ENT for nasofibroscopy and direct laryngoscopy if indicated, and coordinate speech therapy for benign vocal cord pathologies. Any dysphonia persisting beyond 3 weeks in a smoker is treated as a priority with rapid ENT referral. Consultations are available at our service points in Quebec as well as via telemedicine. To book an appointment, visit <a href=\"https:\/\/cliniqueomicron.ca\">cliniqueomicron.ca<\/a>.<\/p>\n\n <p class=\"co-disclaimer\">The content of this page is provided for informational purposes only and does not substitute for the advice of a qualified healthcare professional. Any hoarseness lasting more than 2\u20133 weeks should be evaluated by a doctor, particularly in smokers.<\/p>\n<\/div>\n<\/body>\n<\/html>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Dysphonie (enrouement) : causes, diagnostic et traitement | Clinique Omicron Oto-rhino-laryngologie & M\u00e9decine de famille & Chirurgie cervico-faciale Dysphonie (enrouement) La dysphonie d\u00e9signe toute alt\u00e9ration qualitative ou quantitative de la voix \u2014 modification du timbre (voix rauque, \u00e9raill\u00e9e, voil\u00e9e, souffl\u00e9e), de la hauteur (voix grave ou aigu\u00eb anormale), de l’intensit\u00e9 (voix \u00e9teinte, aphonie partielle) ou… <a href=\"https:\/\/cliniqueomicron.ca\/en\/dysphonie\/\" rel=\"bookmark\">Read More \"<span class=\"screen-reader-text\">Dysphonia (Hoarseness): Causes, Diagnosis, and Treatment | Clinique Omicron<\/span><\/a><\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"off","neve_meta_content_width":100,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","_themeisle_gutenberg_block_has_review":false,"_metasync_otto_title":"Dysphonie (enrouement) : Diagnostic et traitement | Brossard | Clinique Omicron","_metasync_otto_description":"La dysphonie ou enrouement est une alt\u00e9ration de la voix pouvant indiquer une pathologie des cordes vocales, un reflux laryng\u00e9 ou un cancer du larynx. 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