HOARSENESS AFTER SURGERY

A hoarse voice after surgery is something that people sometimes complain about. Hoarseness after surgery can be temporary or permanent, and can be due to a number of reasons. In common most surgeries that cause hoarseness are performed under general anesthesia, in which a breathing tube is left in the throat during the duration of the surgery.

An endotracheal tube (purple) is a breathing tube placed in the mouth through the vocal folds into the trachea.

Because the endotracheal lies between the vocal folds, there are many ways this can cause hoarseness, including:

• Scars may form on and between the vocal folds, which affect sound produced.
• Pressure on the walls of the larynx, or voice box, caused by the endotracheal tube cause the recurrent laryngeal nerve to not work. This causes vocal fold paralysis, in which one of the vocal folds does not move causing a weak and breathy voice.
• Vocal fold granulomas may form, which prevent the vocal folds from closing completely.
• Arytenoid dislocation, in which one of the cartilages of the larynx is displaced from the placement of the tube can cause a sudded loss of voice that requires surgery to fix.
• Subglottic stenosis and tracheal stenosis prevent air from flowing normally through the voice box, causing an altered voie and difficulty breathing.

Hoarseness may be due to the type of surgery as well. Since the recurrent laryngeal nerve travels from the brain, through the neck, into the chest and then wraps around to control the vocalfolds, it can be damaged during a number of surgeries including.

• Spine surgery such as ACDF (Anterior cervical disc fusion)
• Carotid endarterectomy
• Thyroid surgery
• Lung cancer surgery
• Aortic arch surgery
• Trauma surgery
• Esophageal surgery
• Cardiac surgery

Hoarseness after any of these surgeries may be temporary or permanent due to vocal fold immobility. Even if temporary, voice problems after these surgeries may be alleviated with a vocal fold injection which works immediately.

Hoarseness after surgery is often thought of as “normal” – however, it should be evaluated by a laryngologist or otolaryngologist. Often times a procedure or surgery can be performed which is minimally invasive but substantially improves the voice.