Have you ever been advised to drink some calcium if you have a hoarse voice?  Any advice is certainly welcome when our quality of life decreases even the slightest, even if it is because of a hoarse voice. But what exactly is the link between calcium and a hoarse voice?

What lies behind the hoarse voice?

  Dysphonia or hoarseness can occur as a result of any disorder in vocal cord closure, vibration, or symmetry of the vocal cords themselves. Roughness most often indicates a lesion (such as nodules, polyps, cysts, fibrous masses, pseudocysts, and nonspecific lesions) at the vibrating edge of the vocal cords. A shortness of breath or a weak voice may indicate impaired vocal cord closure, as in the case of vocal cord paralysis. In the case where there is no specific anatomical “culprit” such as a tumour, patients with hyperfunctional dysphonia, i.e. non-physiological increase in vocal cord tone during phonation, speech or breathing, develop marked speech difficulties, with accompanying hoarseness. Women are more often affected than men.

Causes of hoarseness can be: acute and chronic laryngitis (inflammation of the throat or larynx), functional dysphonia, benign and malignant tumours, neurogenic factors such as vocal cord paralysis, physiological aging and psychogenic factors.

Larynx and hoarseness

One of the most common causes of hoarseness is acute and chronic laryngitis. The larynx plays an important role in breathing and swallowing in addition to its role in voice production. Acute laryngitis is one of the most common causes of dysphonia. It is most often of viral origin, although acute laryngitis can also be the result of voice abuse or exposure to harmful agents. Acute laryngitis results in reduced vocal cord vibration, which produces sharp, tense voice quality with reduced projection and increased effort. Chronic laryngitis lasts longer and is often caused by chemical irritations such as smoking, air pollutants and inhalers, as well as mechanical irritations from traumatic cough or prolonged speech.

How to cure hoarseness?

Behavioral methods in the treatment of hoarseness include voice hygiene and voice therapy. Vocal hygiene includes increased hydration and hydration to reduce the viscosity of the glottis (glottis is the opening between the vocal cords). Voice rest can often be indicated, which has been shown to be useful in short periods of time to help address edema and inflammatory changes.

In severe cases of hoarseness, such as chronic laryngitis, pharmacological measures may be resorted to. Often patients with chronic laryngitis report heartburn symptoms. In such cases, the patient is referred for proton pump inhibitor therapy.  Furthermore, botulinum toxin may be used. The indication for use is convulsive dysphonia and is usually performed in the office together with electromyography (diagnostic method for examining the function of the peripheral nervous system). Injecting botulinum toxin into the appropriate muscles of the larynx can weaken those muscles and reduce the associated spasm. If nothing proves effective, surgery is resorted to. Hoarseness surgery is always aimed at restoring or preserving the normal voice physiology. 

What about calcium?

There is a described case where a 29-year-old man without a medical history was reported to the emergency medical service with episodes of sudden hoarseness, vomiting after drinking cold water and cramps in his hands. Blood tests showed severe hypocalcaemia and rhabdomyolysis (a syndrome caused by degeneration and destruction of muscle fibres). Rhabdomyolysis is characterized by high concentrations of creatine kinase (CK) in the blood. The patient was immediately treated with intravenous calcium with almost instantaneous improvement in voice and rapid normalization of CK (suggesting that rhabdomyolysis was due to hypocalcemia).  Laryngospasm, which is usually manifested by dyspnoea (difficulty breathing) and stridor (high-frequency sound that occurs predominantly in inspiration), is a rare but well-known and life-threatening consequence of hypocalcaemia that traditionally occurs in infants.

Myth or truth?

In the end, the question from the beginning of the text remains, will calcium help with hoarseness of voice? In the case of hypocalcaemia, which has hoarseness as a symptom, calcium supplements will certainly help. Of course, most people who suffer from hoarseness of voice, especially in the winter months, are more likely to have acute laryngitis than hypocalcaemia. Therefore, voice hygiene and voice therapy are certainly the first choice in the treatment of such cases. If you still think you are suffering from hypocalcaemia, even if it was mild, be sure to consult your doctor or pharmacist before using any calcium supplements!

Translated by Filip Sakoman