Imagine trying to talk with a hot potato in your mouth. Your voice sounds muffled and thick. Your words are hard to understand. This strange way of speaking has a medical name. It is called hot potato voice. And it is a sign of a serious throat problem.
Hot potato voice happens when something blocks the back of your throat. The blockage makes it hard for sound to come out clearly. The most common cause is a peritonsillar abscess. This is a pocket of pus behind the tonsil. It pushes the tonsil inward, blocking the throat.
Other causes include large tonsils, a deep neck infection, or a tumor. Hot potato voice usually comes on suddenly. It is often accompanied by severe sore throat, fever, and trouble swallowing.
This symptom is a medical red flag. Doctors take it very seriously. If you have hot potato voice, you need to see a doctor right away. The cause often needs urgent treatment.
Let’s explore hot potato voice or speech, including its causes, diagnosis, and treatment. We will learn why this symptom is so important to recognize.
Hot Potato Voice or Hot Potato Speech
Hot potato speech, also known as hot potato voice or muffled voice, is pathognomonic of quinsy. It is a medical term, although a misnomer, for distortion or defect in resonance and quality of voice or sound.
In hot potato voice (HPV), the speech has muffled quality, characteristically comparable to a voice produced by a person with a very hot potato in his mouth.
According to The Free Medical Dictionary, “Hot Potato Voice is a term for a defect of resonance in which the speech has a muffled quality, fancifully likened to a person speaking with a hot potato in the mouth.
Etiology: Space-occupying lesions, e.g., lymphoid masses, quinsy—peritonsillar—cellulitis or abscess, tumors of the vallecula between the epiglottis and the base of the tongue”
Synonyms
- Hot potato speech
- Potato in mouth
Important MCQ
‘Hot potato’ voice is characteristically seen in which space infection?
- Retropharyngeal space infection
- Pterygomandibular space infection
- Lateral pharyngeal space infection
- Pre tracheal space infection
To know the answer to this question, keep reading the following notes about the hot potato sound.
A case study of a man with an HPV and neck swelling
By M Irfan and A Puvan Arul
Case history
A man in his late forties came with the complaint of painless left neck swelling for around 4 weeks. He noticed a change in his voice (thick, muffled voice, hot potato speech) 7 days before the onset of the symptoms.
Sore throat and odynophagia were other noticeable symptoms. He didn’t present any symptoms of fever, dysphagia, loss of weight, loss of appetite, or trismus, and there was no history of foreign body in the throat.
Examination and Provisional Diagnosis
Upon examination of the oral cavity, the following abnormalities were seen:
- An enlarged left tonsil occupies more than half of the oropharyngeal space, with a small residual airway.
The provisional diagnosis of this case with hot potato speech is lymphoma.
Hot potato voice causes
The “hot potato voice” is widely recognized as a symptom of peritonsillar cellulitis or abscess. Hot potato speech causes include acute epiglottitis, epiglottic abscess, meningioma (rarely), and others (unknown)
If the cause of a muffled voice is an epiglottic abscess, the patient will have a mild hot potato sound. Tender cervical lymphadenopathy may be present either unilaterally or bilaterally.
A patient with acute epiglottitis will have a muffled voice and the patient often complain of being tired and feeling lethargic due to their labored breathing.
Meningioma presenting as an oropharyngeal mass- an unusual presentation has also been found in the literature.
Is hot potato voice in peritonsilitis a misnomer?
Upon examination of the vocal tract in peritonsilitis, it is found that the hot potato speech is due to dyskinesis of the peritonsillar musculature.
But the muffled speech in people with a hot potato in their mouth is due to the interference in the movement of the anterior tongue. Thus, the changes in the vocal tract differ in these two cases and the title “hot potato voice” in peritonsillitis is a misnomer.
Mechanism of Hot Potato Speech
Hot potato voice is the result of an underlying transient velopharyngeal insufficiency combined with muffled oral resonance. It is classically described for peritonsillar abscess or cellulitis.
The main causes of hot potato voice are already explained. However, it can result from any space-occupying lesions. Frequently seen space-occupying lesions are given below.
- Lymphoid masses
- Quinsy – peritonsillar cellulitis or abscess
- Epiglottitis
- Tumors of vallecula between the epiglottis and the base of the tongue
- Lingual thyroid gland
- Foreign body
In a study, Discrimination of “hot potato voice” caused by upper airway obstruction utilizing a support vector machine, S Fujimura, et al. analyzed changes in the voice spectral envelope caused by upper airway obstructions by using a hybrid time-frequency model of articulatory speech synthesis.
They concluded that HPV caused by upper airway obstruction has a highly characteristic spectral envelope. Based on this distinctive voice feature, the SVM classifier, which was trained using synthetic data, was able to diagnose upper‐airway obstructions with a high degree of accuracy.
Diagnosis
If the cause of the hot potato speech is a peritonsillar abscess, the doctor will first perform an examination of your mouth and throat. They may take a throat culture or a blood test to diagnose your condition. Signs of an abscess include:
- swelling on one side of the throat
- swelling on the roof of the mouth
- redness and swelling of the throat and neck
Lymph nodes are often enlarged on the same side.
CT scans or MRIs are performed to see the abscess more closely. The doctor might also use a needle to draw fluid from the abscess. This fluid will be tested to check if there is an infection.
Treatment of Hot Potato Speech
The treatment of HPV depends upon the underlying cause of the space-occupying lesion. Antibiotics are the most common form of treatment for peritonsillar abscesses. Your doctor may also drain the pus in the abscess to accelerate healing. This is done by lancing (or cutting) the abscess to release fluids. Your doctor may also use a needle.
If you are unable to eat or drink, you may have to receive fluids for hydration intravenously (through an IV). You may need to take painkillers if you are experiencing a lot of pain.
Watch the video and listen how the hot potato really sounds like
The video on hot potato speech by Larry Mellick
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Sources
- Frantz TD, Rasgon BM. Acute epiglottitis: changing epidemiologic patterns. Otolaryngol Head Neck Surg 1993;109:457-60.
- The American Society of Radiologic Technologists, 15000 Central Ave. SE, Albuquerque, NM 87123-3917.
- Uchibori M, Odake G, Ueda S, et al. Parapharyngeal meningioma extending from the intracranial space. Neuroradiology 1990; 32(1): 53-55.
- Thompson LD, Gyure KA. Extracranial sinonasal tract meningiomas: a clinicopathologic study of 30 cases with a review of the literature. Am J Surg Pathol 2000; 24: 640-650.
- Weinberger JM, Birt BD, Lewis AJ, et al. Primary meningioma of the nasopharynx: case report and review of ectopic meningioma. J Otolaryngol 1985; 14: 317-322.
- https://pubmed.ncbi.nlm.nih.gov/16360301/
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FAQs
1. What causes hot potato voice?
The most common cause is a peritonsillar abscess. This is a collection of pus behind one of your tonsils. It usually starts as a tonsil infection that spreads. The pus pushes the tonsil toward the middle of your throat, blocking sound. Other causes include very large tonsils, an infection deep in the neck, a tumor, or swelling from an allergic reaction. Hot potato voice means something is physically blocking your throat.
2. What other symptoms come with hot potato voice?
Hot potato voice usually comes with other symptoms. Most people have a severe sore throat, often worse on one side. You may have a fever, often over 101°F. You may have trouble swallowing, even saliva. Your voice sounds muffled and thick. You might drool because it hurts to swallow. You may have ear pain on the same side. You might feel like you have a lump in your throat. If you have these symptoms together, seek medical help immediately.
3. How is hot potato voice treated?
Treatment depends on the cause. For a peritonsillar abscess, the doctor needs to drain the pus. This can be done with a needle or by making a small cut. You will also need antibiotics. For large tonsils that keep causing problems, you may need surgery to remove them. For deep neck infections, you may need IV antibiotics and sometimes surgery. For tumors, treatment may include surgery, radiation, or chemotherapy. The key is to get diagnosed quickly so treatment can start.