Hoarseness

What is hoarseness?

Hoarseness (dysphonia) is when your voice sounds rough, raspy, strained or breathy. Hoarseness may affect how loud you speak or your voice’s pitch (how high or low your voice sounds). Many things cause hoarseness, but it’s rarely a sign of a serious illness.

Is hoarseness common?

Hoarseness is very common. About 1 in 3 people will have it at some point in their lives. It often affects people who smoke and those who use their voices professionally like teachers, singers and actors, sales representatives and call center employees.

What are the symptoms of hoarseness?

The following symptoms may mean you have hoarseness:

• Your voice sounds as if you’re having a hard time talking.
• Your voice sounds raspy or breathy.
• You’re speaking more quietly or softer than usual.
• Your voice sounds higher or lower than usual.

When should I be worried about hoarseness?

Most hoarseness happens because you overuse your voice and goes away on its own. But you should talk to a healthcare provider if your voice is hoarse for three weeks or longer or if there are other concerning signs. Contact a provider right away if you notice that:

• It hurts when you speak or swallow.
• It’s hard to breathe or swallow.
• You’re coughing up blood.
• There’s a lump in your neck.
• You’ve lost your voice.

What causes hoarseness?

To understand why you get hoarse, it may help to know how your voice works. You can speak thanks to your vocal folds (vocal cords) and larynx (voice box). Your larynx sits above your trachea (windpipe) — a long tube that connects your larynx to your lungs.

Your vocal cords are two bands of tissue inside your larynx that open and close. When you speak, air from your lungs makes your vocal cords vibrate and create sound waves. Anything that affects your vocal cords and larynx can make you sound hoarse, including:

• Laryngitis. This is the most common hoarseness cause. It happens when allergies, upper respiratory infections or sinus infections make your vocal cords swell.
• Using your voice more than usual or in different ways. For example, you can become hoarse after making a long speech. Cheering or yelling can affect your voice. So can speaking in a pitch that’s higher or lower than your normal pitch.
• Age. Your vocal cords get thin and limp as you age, which can affect your voice.
• GERD (chronic acid reflux). Also known as heartburn, GERD is when your stomach acids go up into your throat. Sometimes the acids can go as high as your vocal cords, and that’s known as laryngopharyngeal reflux (LPR).
• Vocal cord hemorrhage. This happens when a blood vessel on a vocal cord ruptures, filling the muscle tissues with blood.
• Vocal nodules, cysts and polyps. Nodules, polyps and cysts are noncancerous growths on your vocal cords.
• Vocal cord paralysis. Vocal cord paralysis means that one or both of your vocal cords don’t open or close as they should.
• Recurrent respiratory papillomatosis (RRP/laryngeal papillomatosis). This condition creates benign (noncancerous) warts on and around your vocal cords.
• Spasmodic dysphonia. This chronic neurological speech disorder changes the way your voice sounds.
• Muscle tension dysphonia. This occurs when you put too much stress on your vocal cords and the muscles get tight. It can also be the result of an injury to the neck, shoulders or chest.
• Neurological diseases and disorders. If you have a stroke or Parkinson’s disease, your condition may affect the part of your brain that controls the muscles in your larynx.
• Cancer. Cancers including laryngeal cancer, lung cancer and throat cancer may make you sound hoarse.

How is hoarseness diagnosed?

Depending on your symptoms, your usual healthcare provider may refer you to an otolaryngologist, a provider who specializes in treating ear, nose and throat conditions. After getting your medical history and a list of your medications, your provider may ask the following questions:

• How long have you had hoarseness?
• Did your symptoms start suddenly or come on gradually?
• Did you have an upper respiratory infection recently?
• Do you have other symptoms?
• Do you smoke? If so, for how long?
• Do you drink alcohol?

What tests will be done to diagnose hoarseness?

Your provider will listen to your voice and examine your head and neck for lumps. They may do the following tests:

• Laryngoscopy.
• Videostroboscopy.
• Computed tomography (CT) scan.
• Magnetic resonance imaging (MRI).
• Biopsy.

What are treatments for hoarseness?

Treatment depends on the reason why you’re hoarse:

Some types of cancer or neurological diseases may cause hoarseness. If you’re hoarse because you have cancer or neurological issues, a healthcare provider who specializes in those issues will treat the underlying cause.

Can hoarseness be prevented?

Sometimes hoarseness is linked to medical conditions that you may not be able to prevent. But you can prevent hoarseness by taking care of your voice, particularly if you use it every day for a long time. (Think teaching, singing or public speaking.) Here are some suggestions:

• Quit smoking (your provider can provide resources to help with this). Stay away from secondhand smoke.
• Avoid beverages that have alcohol and/or caffeine.
• Drink plenty of water.
• Use a humidifier.
• Avoid spicy foods.
• Avoid activities that strain your voice, like speaking for a long time, speaking loudly or shouting.
• Use an amplifying device like a microphone or megaphone when you do activities that could strain your voice.

What can I expect if I have hoarseness?

In general, you can expect to have your voice back after resting it or receiving treatment for the underlying cause. Rarely, hoarseness is a symptom of serious illnesses like cancer or a neurological disorder.

How do I take care of myself?

If you have hoarseness, following your healthcare provider’s instructions is the best way for you to get your voice back.

When should I see my healthcare provider?

You should contact your provider if you’re still hoarse despite treatment or you notice your symptoms are getting worse.

What questions should I ask my healthcare provider?

Hoarseness is a common issue. If you have hoarseness, you may want to ask your provider the following questions:

• Why am I hoarse?
• Is the cause a serious medical issue?
• What treatments do you recommend?
• What can I do to take care of myself?

A note from Cleveland Clinic

Silence may be golden, but not when hoarseness makes it hard for you to speak, your voice sounds different, or you lose it entirely. Contact a healthcare provider if hoarseness lasts for three weeks or if it’s hard or painful when you swallow or breathe, you’re coughing up blood, have a lump in your neck or it's been a few days since you’ve been able to use your voice. Your provider will find out why you’re hoarse and help you regain your voice.