Hoarseness

What is hoarseness (dysphonia)?

Hoarseness (dysphonia) is when your voice sounds raspy, strained or breathy. The volume (how loud or soft you speak) may be different and so may the pitch (how high or low your voice sounds). There are many causes of hoarseness but, fortunately, most are not serious and tend to go away after a short time.

How does the voice work?

You can speak thanks to your vocal folds (vocal cords) and larynx (voice box). Your larynx sits above your trachea (windpipe) – the airway that goes down to your lungs. The vocal cords, which are two bands of muscle, are inside your larynx, and they open and close. When you speak, air from your lungs makes the cords vibrate, creating sound waves. If you relax (shorten) your vocal folds, your voice will sound deeper. It will be higher pitched if the vocal folds tense or elongate.

How common is hoarseness?

Hoarseness is very common. About one-third of people will have it at some point in their lives.

Who is at risk of getting hoarseness?

Anyone at any age can experience hoarseness. This symptom is most common in people who smoke and those who use their voices professionally like teachers, singers, sales representatives and call center operators

Can hoarseness be a sign of lung cancer?

Hoarseness can be a symptom of lung cancer. It’s more commonly associated with laryngeal cancer.

Can hoarseness be a sign of heart problems?

No. Your vocal cords and larynx do not affect your heart.

Can hoarseness be caused by stress?

Yes, stress (mental/emotional) is one of the more common causes of hoarseness.

Can post nasal drip cause hoarseness?

Yes. Post nasal drip is one of several possible causes of hoarseness.

Is hoarseness a symptom of throat cancer?

Hoarseness can sometimes be a symptom of laryngeal cancer.

What causes hoarseness?

There are several possible causes of hoarseness. Many are harmless. Causes include:

• Using your voice too much. If you talk too long, cheer too loudly, sing too much or speak in a pitch that’s higher or lower than usual, you may experience hoarseness. Also, your vocal cords naturally get thin and limp with age. It’s perfectly common for your voice to get raspier as you get older.
• A cold or sinus infection. This should go away on its own within two weeks.
• Laryngitis. This is when your vocal folds temporarily swell from allergies, a cold or an upper respiratory infection.
• Gastroesophageal reflux (GERD). 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 folds, and that’s known as laryngopharyngeal reflux (LPR).
• Vocal fold hemorrhage. If your voice suddenly disappears, or you can speak but not sing, you might have had a vocal fold hemorrhage. This happens when a blood vessel on a vocal fold ruptures, filling the muscle tissues with blood.
• Neurological diseases and disorders. If you’ve had a stroke or Parkinson’s disease, your condition may have affected the part of your brain that controls the muscles in your larynx.
• Vocal nodules, cysts and polyps. Nodules, polyps and cysts are noncancerous growths that can form on your vocal folds. They form because of too much friction or pressure.
• Vocal fold paralysis. Vocal fold paralysis means that one or both of your vocal cords don’t work properly. One or both might not open or might not close. The cause is usually not known, but sometimes it happens because of an injury, lung or thyroid cancer, infection, multiple sclerosis, stroke, Parkinson’s disease or tumors.
• Laryngeal cancer. Hoarseness that lasts more than three weeks can be a symptom of laryngeal cancer.
• Recurrent respiratory papillomatosis (RRP/laryngeal papillomatosis). This disease causes noncancerous tumors on your air passages.
• Muscle tension dysphonia. Muscle tension dysphonia is a change in the sound or the feel of your voice due to excessive muscle tension in and around your voice box. This tension prevents your voice from working efficiently. Muscle tension dysphonia is a pattern of muscle use that can develop during laryngitis and remain even after swelling of the vocal cords has gone. It can also be caused by stress and can co-occur with other conditions.

How is hoarseness diagnosed?

Depending on your symptoms, your usual healthcare provider may refer you to an otolaryngologist or ENT (ears, nose and throat specialist). After getting your medical history and a list of your medications, your ENT may ask the following questions:

• How long have you had hoarseness?
• Did your symptoms start suddenly or come on gradually?
• Did you have a previous upper respiratory infection?
• Do you have other symptoms?
• Do you smoke?
• How long have you been smoking?
• Do you drink alcohol?

After that, your ENT will want to listen to your voice and examine your head and neck. They’ll check for any lumps in your neck and examine your voice box using a laryngoscope, which is a lightened instrument that will be inserted into the back of your throat through your nostrils. If there is cause for concern, your healthcare provider may order the following tests:

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

How is hoarseness treated?

Treatment depends on the condition causing the hoarseness. The conditions and their treatments include:

• Using your voice too much. Rest your voice (don’t use it for time). Drink water.
• A cold or sinus infection. Let the common cold run its course, or take over-the-counter cold medicines.
• Laryngitis. Talk to your healthcare provider. You may be prescribed antibiotics or corticosteroids.
• Gastroesophageal reflux (GERD). There are a variety of treatment options for GERD, including antacids and proton pump inhibitors.
• Vocal fold hemorrhage. Voice rest.
• Neurological diseases and disorders. There are a variety of treatment options for each neurological disease and disorder.
• Vocal nodules, cysts and polyps. Dietary changes and voice therapy with a speech-language pathologist. Surgery is sometimes recommended.
• Vocal fold paralysis. A simple procedure performed by an ENT may push a paralyzed vocal fold back towards the center, or a more complicated surgery may be necessary.
• Laryngeal cancer. Treatment options include radiation therapy, chemotherapy, immunotherapy and surgery.
• Recurrent respiratory papillomatosis (RRP/laryngeal papillomatosis). Like nodules, papillomas are benign (noncancerous) growths. Procedures are done to remove the growths and make sure your airways are clear.
• Muscle tension dysphonia. Treatment options observation or voice therapy with a speech-language pathologist.

If you experience hoarseness repeatedly because you use your voice so much every day, you might need to see a speech-language pathologist for voice therapy. There are exercises you can do and you’ll be taught how to use your voice to avoid hoarseness.

How can hoarseness be prevented?

There are some easy ways to prevent a hoarse voice. You should practice them especially if you use your voice for professional reasons, particularly if that’s every day. Try the following to help prevent hoarseness:

• Quit smoking. Stay away from second-hand smoke.
• Avoid alcohol and caffeine and other fluids that dehydrate your body.
• Drink plenty of water.
• Use a humidifier.
• Avoid spicy foods.
• Keep yourself from using your voice for too long.
• Keep yourself from using your voice too loudly.

When should my hoarseness be treated by a healthcare provider?

If your voice is still hoarse after three weeks, you should see your healthcare provider. You should see a healthcare provider before then if you have any of the following:

• Difficulty breathing.
• Pain when speaking.
• Pain when swallowing.
• Coughing up blood.
• Difficulty swallowing.
• A lump in your neck.
• No voice at all for more than a few days.

A note from Cleveland Clinic

Your voice is one of the most important tools for communication, so it’s important to keep it working well. Hoarseness can be annoying or – if you use your voice professionally – distressing. Take care of your voice by drinking enough water, avoiding caffeine and smoking and using a microphone or other amplification tool if you need to speak loudly. Remember to see your healthcare provider if the hoarseness lasts three weeks.