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What causes intermittent hoarseness and loss of voice?

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Posted on Mon, 9 Mar 2015
Question: I have had hoarseness come and go approx 4 times since October. December 26th I nearly completely lost my voice and it was gone for almost 2 weeks. It came back for one week and then I lost it again on January 19th and it was gone for two solid weeks until Feb 3rd. I also clear my throat a lot but other than that I have no other symptoms.
I saw an ENT who did a nasopharyngoscope. Everything appeared normal. He then sent me for a CT scan. That showed that my larynx, voice box and vocal cords all appear normal. The CT scan did show though that I have 2 thyroid nodules on the right side.
One measuring .5mm and the other 1.4 cm. My ENT dr says that it is unlikely to have nodules cause hoarseness unless cancer is present. I can either do a biopsy and confirm that it is cancer or I can go straight to surgery and skip the biopsy. The dr. of course suggests the biopsy first but has left the decision up to me. I am leaning more toward surgery without a biopsy.
My question is has anyone had experience with recurrent hoarseness with no known cause that ended up not being cancer? What is the chance that it actually is cancer? Is it so likely to be cancer that it would be practical to just go straight to surgery without a biopsy? Is there really anything else this could be?
I greatly appreciate any help!!
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Answered by Dr. Sumit Bhatti (1 hour later)
Brief Answer:
Unlikely to be cancer, FNAC of the nodules, Stroboscopy.

Detailed Answer:
Hi,

Thank you for your query.

1. The hoarseness due to cancer does not recover off and on. The hoarseness persists and worsens.

2. Hence your recurring hoarseness is more likely to be a benign cause such as chronic laryngitis, acid relux and allergy.

3. Surgery should never be done without a biopsy or FNAC (Fine Needle Aspiration Cytology) except in certain situations such as very vascular tumors.

4. The thyroid nodules are common and the incidence in female patients is higher than in male patients. Unless these nodules are directly pressing upon the recurrent laryngeal nerve, they are unlikely to be of consequence and more of incidental findings. They can be investigated further.

5. Get a Stroboscopy done which will enable the vocal cords to be studied in detail. This should also be done during an episode of hoarseness.

6. All hoarseness is not due to cancer. If you can upload your Stroboscopy video, I will be able to give you an accurate assessmennt.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Sumit Bhatti

Otolaryngologist / ENT Specialist

Practicing since :1991

Answered : 2601 Questions

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What causes intermittent hoarseness and loss of voice?

Brief Answer: Unlikely to be cancer, FNAC of the nodules, Stroboscopy. Detailed Answer: Hi, Thank you for your query. 1. The hoarseness due to cancer does not recover off and on. The hoarseness persists and worsens. 2. Hence your recurring hoarseness is more likely to be a benign cause such as chronic laryngitis, acid relux and allergy. 3. Surgery should never be done without a biopsy or FNAC (Fine Needle Aspiration Cytology) except in certain situations such as very vascular tumors. 4. The thyroid nodules are common and the incidence in female patients is higher than in male patients. Unless these nodules are directly pressing upon the recurrent laryngeal nerve, they are unlikely to be of consequence and more of incidental findings. They can be investigated further. 5. Get a Stroboscopy done which will enable the vocal cords to be studied in detail. This should also be done during an episode of hoarseness. 6. All hoarseness is not due to cancer. If you can upload your Stroboscopy video, I will be able to give you an accurate assessmennt. I hope that I have answered your query. If you have any more questions I will be available to answer them. Regards.