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What to Do If Your Voice Is Hoarse

Updated on Jun 30, 2022 | Ear Nose Throat, Your Health

Dysphonia, or hoarseness, affects approximately one-third of people under the age of 65 during their lifetime. This climbs to nearly 80 percent for high vocal users—like teachers and singers—and those over the age of 65. Symptoms of dysphonia include vocal fatigue, pitch changes, voice breaks, unintended volume changes, increased vocal effort, and decreased quality.

Hoarseness can range from temporary voice changes caused by a viral infection to a severe disability that makes basic communication difficult.

If you are seeking medical care for hoarseness, you doctor can now consult the updated Clinical Practice Guideline: Hoarseness (Dysphonia). Recently released by The American Academy for Otolaryngology-Head and Neck Surgery, the Clinical Practice Guideline details how your doctor can best treat this often irritating condition.

Matthew C. Mori, MD, Assistant Professor of Otolaryngology-Head and Neck Surgery at the Icahn School of Medicine at Mount Sinai and a laryngologist at the Grabscheid Voice and Swallowing Center, offers answers to some of the most frequently asked questions.

When should I see a health care provider about my hoarseness?

According to the recent Clinical Practice Guideline: Hoarseness (Dysphonia), you should see a health care provider if:

Your hoarseness does not go away or get better in 7-10 days. (It’s especially important to see a doctor if you are a smoker.)
You do not have a cold or flu
You are coughing up blood
You have difficulty swallowing
You feel or see a lump in your neck
Your loss of, or the severe changes in, your voice last longer than a few days
You experience pain when speaking or swallowing
Your voice change comes with uneasy breathing
Your hoarseness makes your work hard to do
You are a vocal performer (singer, teacher, public speaker) and cannot do your job

Do I need antibiotics, steroids, or imaging (such as an X-ray, CT scan, MRI)?

Maybe. However, except for some special cases, you will not need medications or imaging before a specialist looks at your vocal cords or larynx. The Clinical Guidelines recommend against these routine treatments prior to examination of the larynx. However, after an in-office laryngoscopy (examination of the larynx or vocal cords), one or more of these treatments may be prescribed. Acute hoarseness is often caused by laryngitis from a viral infection, making antibiotics ineffective. Additionally, corticosteroids should be avoided unless indicated due to the risk of rare, but serious, adverse effects.

What is voice therapy?

Voice therapy is a well-established program to treat many causes of hoarseness. It involves a trained speech language pathologist guiding you through voice and physical tasks as well as behavioral changes to help you shape healthy vocal behavior and attain the best possible voice. Voice therapy is the first-line therapy for behavior-related vocal lesions like vocal nodules and polyps. With few exceptions, it is covered under insurance.

Do I need surgery to treat my hoarseness?

This depends on the cause of the hoarseness. Lifestyle changes and voice therapy may be enough. But some patients may need surgery to improve the voice due to benign vocal cord lesions—like cysts or polyps—which have not responded to more conservative treatments. Also, if there is a paralysis of the vocal cord, or a form of muscular weakness known as paresis, an injection or implant may be required. If there is a possibility of a malignancy or cancer, surgery or an in-office biopsy would be required to make a diagnosis.

Is it better to wait to see if my hoarseness goes away on its own?

If your voice has not improved after 7-10 days, you should be evaluated by a health care provider. With any problem of the vocal cords, the earlier you start treatment the better.

If your hoarseness persists for more than four weeks, you should be seen by an otolaryngologist, also known as an ear, nose, and throat (ENT) surgeon.

Call 212-241-9425 to schedule an appointment with Dr. Mori

Matthew C. Mori MD is an Assistant Professor of Otolaryngology at the Icahn School of Medicine at Mount Sinai. He is a board certified and fellowship trained surgeon, and a laryngologist at the Grabscheid Voice and Swallowing Center of Mount Sinai. Dr. Mori specializes in the diagnosis and treatment of airway, voice, and swallowing disorders while treating the full gamut of ear, nose, and throat disease.

Avoiding Dysphonia

Preventative measures should be taken to avoid hoarseness, especially for high vocal users. Try the following to avoid the irritating disorder:

Drink water daily. Dehydration is bad for you and your vocal chords.
If you are in dry, arid conditions, try using an indoor humidifier.
Be sure to rest your voice to avoid over-straining.
Avoid smoking and second-hand smoke which can irritate your airway.
Minimize excessive throat clearing or coughing.
Limit drying beverages like alcohol and caffeine.

For additional tips on preventative measures that can be taken to reduce hoarseness, consult this chart from the Clinical Practice Guideline.

How Dialysis Patients Can Increase Protein While on a Budget

Mar 18, 2018 | Diet and Nutrition, Your Health

For those on dialysis, registered dietitians can sometimes sound like a broken record: “EATMOREPROTEINEATMOREPROTEINEATMOREPROTEIN!”

There’s a reason why this is your nutritionist’s mantra. Protein is extremely important for dialysis patients, because the treatment filters out protein. If you are on dialysis, you must replace the nutrients lost; otherwise, you may experience muscle wasting and fatigue, or your immune system may not function well.

Anyone who has ever gone food shopping knows that protein-rich foods, such as meat and fish, tend to be the most costly items in your shopping cart. However, it is possible to buy protein without breaking the bank.
Try adding the following inexpensive, protein-rich options to your diet:

Eggs

Compared to meat and fish, eggs are a relatively inexpensive yet potent source of protein—a three-egg omelet has as much protein as a three-ounce burger. While eggs have gotten a bad rap because of their cholesterol content, it is important to note that the dietary cholesterol found in eggs will not raise your blood cholesterol as much as saturated fats like those found in sausage, fried foods, and cheese. Also, most people on hemodialysis tend to have low cholesterol levels. Be sure to check with your doctor or nutritionist before adding more eggs into your diet.

Fish

While salmon and tuna are great, economical options such as perch or tilapia are delicious and have just as much protein. Cut down on costs by purchasing fillets which limit waste and have the lowest price per pound. If you shop at a local fish store, go at the end of the day. They may cut the price to clear out the day’s inventory, in order to make room for tomorrow’s catch.

Additionally, canned tuna is a good buy and markets often have it on sale. Chunk light tuna has just as much protein as white tuna for a lower price. Salt-free tuna tends to cost more. Remove salt at home by emptying a can of regular tuna in a strainer, then run under water.

Chicken and Turkey

Chicken and turkey are relative bargains. A whole chicken is usually inexpensive and will feed an entire family. Leave leftovers for later in the week if you live alone. You can use the bones to make soup stock. If you prefer boneless chicken, the thigh tends to be cheaper than breast and has just as much protein. Also, ground chicken and turkey make great burgers.

Meat

When shopping for red meats, go for lower-priced cuts. Round steak is cheaper than sirloin or club steak and very high in protein.

In addition to the above, dialysis patients should check their phosphorus levels with their doctor or registered dietitian. If levels are low or well controlled, beans or cheese may be incorporated as an inexpensive, and tasty, protein source.

Remember: there is no pill that you can take to increase this important fuel source. The only way to get enough protein is through nutritious food.

Shop Smart

Use these tips to optimize your grocery shopping:

Prevent expensive impulse purchases by checking your supermarket’s weekly ads and deciding what sale items you will buy in advance.
Fast foods may seem fairly inexpensive, but for the price of a single meal, you could have bought a whole chicken or two dozen eggs and gotten a lot more protein per dollar spent.
If you get some of your food at a pantry, you may find that many of the items offered, like beans and canned meats, are not ideal for dialysis patients. Take them anyway. You may have family members who can eat those foods, leaving some room in your total family budget for you to buy alternate protein.

Metro New York’s Ask Mount Sinai: This is what happens to your mind and body when you don’t get enough sleep

Mar 12, 2018 | Your Health

Adults need seven hours of sleep every 24 hours, but we often don’t get enough. Boris Chernobilsky, MD, director of Sleep and Airway Surgery at Mount Sinai Downtown-Union Square, explains why sleep is so essential.

Read the article in Metro New York

How Do I Go Vegan and Stay Healthy?

Mar 9, 2018 | Diet and Nutrition, Your Health

Veganism is trending. The controversial documentary “What the Health?” recently ignited conversation with its claim that eating animal products leads to increased disease risk. While many health professionals do not endorse the film’s claims due to a lack of supporting evidence, the idea that a diet consisting of poor-quality, cheap meat and dairy foods would be harmful in the long term is not surprising.

Whether prompted by the documentary or by celebrities promoting the values of an all-plant diet, veganism is in the news. Luckily, many vegan products are on the market, which definitely makes it easier to become vegan today. However, you should still seek guidance before jumping on board. Here are a few things to keep in mind:

Talk with your doctor

Regardless of why you want to go vegan, it is a major lifestyle change, and your health care provider should advise on how to prevent nutritional deficiencies. This is especially true for children and young adults. Before going vegan, I recommend undergoing a full blood workup. Checking lab values—such as iron, B12, and calcium/vitamin D—could be a good tool to know where you are starting from and what foods should be encouraged.

Consider Vegan-ish

It may not be necessary to go totally vegan. Ever heard of a flexitarian? That’s someone who is mostly vegan but eats meat occasionally. In addition, purchasing the best quality meat and dairy items, and only consuming them a couple days a week, may be a good step toward a healthier diet without worrying about deficiencies and relying on supplements.

Going vegan is not the same as dieting

Going vegan does not necessarily mean that you will lose weight. A lot of people end up overeating processed carbohydrates and actually gain weight. Being vegan is not a crash diet but a lifestyle change that takes a lot of planning. For example, you should experiment with non-dairy cheeses and make a list of all the plant-based proteins to structure into your day.

Remember, becoming vegan is a dietary change that should be managed with care. Be sure to consult your doctor before taking the plunge.

Chair of Geriatrics and Palliative Medicine Builds On Success in Improving Patients’ Quality of Life

Mar 6, 2018 | Featured, Your Health

R. Sean Morrison, MD, at the Wiener Family Palliative Care Unit at The Mount Sinai Hospital, which recently earned recertification by The Joint Commission.

R. Sean Morrison, MD, has been appointed Ellen and Howard C. Katz Chair of the Brookdale Department of Geriatrics and Palliative Medicine at Icahn School of Medicine at Mount Sinai. Dr. Morrison, who joined Mount Sinai in 1995, has focused on one goal throughout his career: Improving quality of life for patients and families.

“Our mission is to ensure that persons living with serious illness, multiple chronic conditions, physical disability, or cognitive impairment live as well and as long as possible,” Dr. Morrison says. “We try to establish what goals are important to our patients and help them to achieve them.”

Dr. Morrison will continue as Director of the Hertzberg Palliative Care Institute and the National Palliative Care Research Center. He succeeds Albert L. Siu, MD, who was chair of the department for 15 years. “My No. 1 objective is to build on the success of my predecessors—Drs. Robert Butler, Christine Cassel, and Albert Siu. They created the first Department of Geriatrics, and then the first integrated Department of Geriatrics and Palliative Medicine in the country, and built it into the nation’s leading academic program focused on the needs of older adults and those with serious illness.”

The Mount Sinai Hospital’s geriatrics program ranked third in the nation in the 2017–2018 U.S. News & World Report “Best Hospitals” Guide. And in February, the palliative care programs at The Mount Sinai Hospital and Mount Sinai Beth Israel earned recertification by The Joint Commission. “Mount Sinai was one of the first five hospitals to receive Advanced Certification in Palliative Care in 2011,” Dr. Morrison says. “Since that time, our teams, sites, and number of patients have multiplied considerably. Yet our services continue to offer an unwavering quality of care to seriously ill patients and their families.” He thanked the Mount Sinai Health System’s leadership for their support and thanked every team member for their dedication “to removing unnecessary suffering from the world.”

Dr. Morrison earned his MD at the University of Chicago Pritzker. He completed his residency at New York-Presbyterian Weill Cornell Medical Center and his fellowship training in geriatric medicine at the Icahn School of Medicine at Mount Sinai. In 1995, he helped found Mount Sinai’s palliative care program which started with a team of four: Dr. Morrison, Jane Morris, MS, RN, ACHPN; Judith Ahronheim, MD; and another national leader in palliative care, Diane E. Meier, MD, who is a MacArthur Fellow and the Catherine Gaisman Professor of Medical Ethics, and Professor of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai. Dr. Meier now serves as the Director of Mount Sinai’s Center to Advance Palliative Care, an organization that Dr. Morrison collaborates closely with in disseminating innovative models of palliative care education and practice throughout the United States.

At the time that palliative care started at Mount Sinai, it was a novel team-based specialty focused on providing specialized medical care to relieve the symptoms and stress caused by the serious illness for patients and their families. It is still appropriate at any age and at any stage in a serious illness, and unlike hospice, it can be provided alongside curative and all other appropriate medical treatments. “As a result of the research, educational outreach, and clinical-care models developed at Mount Sinai, palliative care is now available in all major hospitals across the country making it one of the fastest growing specialties in American medicine,” Dr. Morrison says.

This is a crucial time for geriatrics and palliative care. “Those over age 80 are the fastest growing segment of the American population, and older adults living with serious and complex medical illness account for more than 60 percent of all health care spending,” Dr. Morrison says. “As baby boomers continue to age, all health care professionals will need to have the core knowledge and skills of geriatrics and palliative care in order to deliver high value health care.”

His goals for the Department are: to develop new models of high value clinical care to match the needs of an aging population; to create the science and evidence base that supports the care; and to train a work force that is well-prepared to care for older adults and those with serious illness. “This is the Department that created the fields of geriatrics and palliative care,” Dr. Morrison says. “My hope is that we become the Department that is responsible for completely infusing these specialties into the genome of American medicine.”

Remote Monitoring Improves Readmission Rates for Heart Failure Patients

Mar 6, 2018 | Featured, Research, Your Health

Sean P. Pinney, MD

Mount Sinai Heart is reducing readmissions and improving quality of life for congestive heart failure (CHF) patients with remote monitoring using new devices and apps, as well as old-fashioned compassionate care.

“We are creating a multimodal way of keeping an eye on our patients after they have left the hospital so that we can optimize their medications and keep them at home—where they want to be—rather than in the hospital,” says Sean P. Pinney, MD, Professor of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai, and Director of Heart Failure and Transplantation, Mount Sinai Health System.

One of the strategies involves the ReDS™ (Remote Dielectric Sensing) system, a wearable vest made by Sensible Medical Innovations. ReDS is based on technology that allows the military to “see through walls” and find survivors in collapsed buildings. In a medical setting, a device sees through the walls of the chest, sending an electromagnetic beam through the middle lobe of the right lung, measuring the lung fluid. Based on the readings, a physician might decide to raise or lower the dosage of diuretics, or hospitalize the patient if there is an extreme overload of fluid.

Dr. Pinney’s team is participating in a randomized multicenter clinical trial of the device, sponsored by Sensible Medical, that began in September 2015 and is to be completed in June 2018. The trial will compare the readmission rates of 380 patients hospitalized for heart failure. All participants are receiving the standard care, including follow-up phone calls and outpatient visits, but one group also goes home with a ReDS vest, with their readings transmitted to care providers. Since July 2017, Mount Sinai has also been using the device in its Rapid Follow-Up Clinic for recently discharged CHF patients. “We are one of only three centers to do this, so we are in the vanguard,” Dr. Pinney says. Among the 28 patients who have used the system since July, the 30-day readmission rate was about 9 percent, compared with 22 percent for heart failure patients overall.

The CardioMEMS™ device is an implanted sensor, about as wide as a dime, that checks for increased pressure in the pulmonary artery.

Mount Sinai is an early adopter of another device, CardioMEMS™, an implanted sensor made by Abbott that checks for increased pressure in the pulmonary artery—an early indicator of worsening heart failure. A small pressure sensor is implanted in the pulmonary artery using a catheterization procedure. Sensor readings are wirelessly transmitted to a secure website for clinicians. “If the pressures rise, we increase medication, and if they come down too low, we cut back,” Dr. Pinney says. “So it gives us a feedback loop to get smarter about prescribing medicine.”

Mount Sinai is also using apps to help monitor CHF patients. One is HealthPROMISE, a system for iPhone and Android, developed by the Mount Sinai AppLab. Patients are sent home with a blood pressure cuff and a scale that send data through the app to care providers. “We can track blood pressure, weight, and the answers to simple questions about the patients’ symptoms,” Dr. Pinney says.

A pilot study by Dr. Pinney’s team found that of 52 subjects using the app, four were readmitted within 30 days of discharge. “The CHF patients had a 7 percent readmission rate compared to the national readmission rate of more than 25 percent within 30 days of discharge,” according to an abstract of the study, presented in October 2017 at the Connected Health Conference in Boston.

Another app, being developed by Dr. Pinney’s group and a startup company, RecoverLINK, is also in clinical trials. It works similarly to HealthPROMISE but asks more detailed questions about patients’ symptoms, mood, compliance with medication, and general quality of life. In addition to remote monitoring, patients also receive personalized video messages from providers.

Dr. Pinney says that heart failure patients often underestimate the severity of their condition, saying “I just have a weak heart,” when the median survival after diagnosis is about five years—“as bad as many cancers, or worse.” He sees a significant opportunity to improve the lives of CHF patients. “There is a need to identify these individuals, refer them to a heart failure center of excellence like ours at Mount Sinai, and take advantage of the pharmacologic and device therapies that now exist.”