Diseases & Conditions

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Hoarseness Overview

Hoarseness is a symptom and not a disease. It is a general term that describes abnormal voice changes. When hoarse, the voice may sound breathy, raspy or strained, and there also may be changes in volume (loudness) or pitch (how high or low the voice is).

The changes in sound are usually due to disorders related to the vocal folds, the sound-producing parts of the voice box (larynx).

Causes

Fortunately, hoarseness does not tend to be long-lasting nor does it tend to be indicative of a serious condition. However, if it persists longer than two weeks, a visit to your doctor is recommended, as persistent hoarseness can be a warning sign of cancer.

Causes of hoarseness include:

  • Common cold or upper respiratory tract viral infection
  • Voice abuse: When you use your voice either too much, too loudly, or improperly over extended periods of time.
  • Gastroesophageal reflux: When stomach acid moves up the swallowing tube, irritating the vocal folds.
  • Smoking
  • Allergies, thyroid problems, neurological disorders, rheumatoid arthritis and trauma to the voice box

Diagnosis

When a physical exam for hoarseness is performed, clinicians begin by getting a thorough history of your hoarseness and assessment of your general health. Your voice box and surrounding tissue will be examined using a mirror or a laryngoscope, a small lighted flexible instrument placed in the back of your throat.

Voice quality is also evaluated with the following criteria:

  • A breathy voice may suggest poor vocal cord function, which may be caused by a benign tumor, polyp or cancer of the larynx.
  • A raspy voice may indicate vocal cord thickening due to swelling, inflammation from infection or a chemical irritant, voice abuse or paralysis of the vocal cords.
  • A high, shaky voice or a soft voice may suggest trouble getting enough breathing force or air.

Lastly, laboratory testing, including a biopsy, x-rays and thyroid function tests, may be ordered depending on the findings of the physical exam.

Treatment

Treatment varies, depending on the condition causing the hoarseness.

Physicians often recommend that patients: 

  • Rest the voice or modify how the voice is used
  • Stop smoking, if this is applicable, as well as avoid exposure to second-hand smoke
  • Drink plenty of fluids
  • Undergo surgery if there are nodules or polyps on the vocal folds

Prevention

To prevent hoarseness, experts recommend:

  • If you smoke, quit
  • Avoid agents which dehydrate the body, such as alcohol and caffeine
  • Avoid “second hand” (passive) smoke
  • Humidify your home
  • Watch your diet and avoid spicy foods and alcohol
  • Try not to use your voice too long or too loudly
  • Seek professional help if your voice is injured or hoarse

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