Doctor, Why Am I Hoarse?
Insight into causes, prevention, and
when to see an ENT
Hoarseness is a general term that describes abnormal
voice changes. When hoarse, the voice may sound breathy, raspy, strained,
or there 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
cords that are the sound producing parts of the voice box (larynx). While
breathing, the vocal cords remain apart. When speaking or singing, they come
together, and as air leaves the lungs, they vibrate, producing sound. Swelling
or lumps on the vocal cords prevent them from coming together properly and
changes the way the cords vibrate, which makes a change in the voice, altering
quality, volume, and pitch.
|What Are the Causes?
Acute Laryngitis: There are many causes of
hoarseness. Fortunately, most are not serious and tend to go away in a
short period of time. The most common cause is acute laryngitis, which
usually occurs due to swelling from a common cold, upper respiratory tract
viral infection, or irritation caused by excessive voice use such as
screaming at a sporting event or rock concert.
Nodules: More prolonged hoarseness is usually due to using
your voice either too much, too loudly, or improperly over extended periods of time. These habits can lead to vocal
nodules (singers’ nodes), which are callous-like growths, or may lead to
polyps of the vocal cords (more extensive swelling). Both of these
conditions are benign. Vocal nodules are common in children and adults who
raise their voice in work or play.
Reflux: A common cause of hoarseness is gastro-esophageal
reflux, when stomach acid comes up the swallowing tube (esophagus) and
irritates the vocal cords. Many patients with reflux-related changes of
voice do not have symptoms of heartburn. Usually, the voice is worse in
the morning and improves during the day. These people may have a sensation
of a lump in their throat, mucus sticking in their throat or an excessive
desire to clear their throat.
Smoking is another cause of hoarseness. Since smoking is the major cause
of throat cancer, if smokers are hoarse, they should see an
Other Causes: Many
unusual causes for hoarseness include allergies, thyroid problems,
neurological disorders, trauma to the voice box, and occasionally, the
normal menstrual cycle.
Treat My Hoarseness?
Hoarseness due to a cold or flu may be
evaluated by family physicians, pediatricians, and internists (who have learned
how to examine the larynx). When hoarseness lasts longer than two weeks or has
no obvious cause it should be evaluated by an otolaryngologist--head and neck
surgeon (ear, nose and throat doctor). Problems with the voice are best managed
by a team of professionals who know and understand how the voice functions.
These professionals are otolaryngologist--head and neck surgeons,
speech/language pathologists, and teachers of singing, acting, or public
speaking. Voice disorders have many different characteristics that may give
professionals a clue to the cause.
How Is Hoarseness
An otolaryngologist will obtain a thorough history of
the hoarseness and your general health. Your doctor will usually look at the
vocal cords with either a mirror placed in the back of your throat, or a very
small, lighted flexible tube (fiberoptic scope) may be passed through your nose
in order to view your vocal cords. Videotaping the examination or using
stroboscopy (slow motion assessment) may also help with the analysis.
These procedures are not uncomfortable and are well tolerated by most
patients. In some cases, special tests (known as acoustic analysis) designed to
evaluate the voice, may be recommended. These measure voice irregularities, how
the voice sounds, airflow, and other characteristics that are helpful in
establishing a diagnosis and guiding treatment
When should I see
an otolaryngologist (ENT doctor)?
- Hoarseness lasting longer than two weeks
especially if you smoke
- Pain not from a cold or flu
- Coughing up blood
- Difficulty swallowing
- Lump in the neck
- Loss or severe change in voice lasting longer
than a few days
Vocal Disorders Treated?
The treatment of hoarseness depends on
the cause. Most hoarseness can be treated by simply resting the voice or
modifying how it is used. The otolaryngologist may make some recommendations
about voice use behavior, refer the patient to other voice team members, and in
some instances recommend surgery if a lesion, such as a polyp, is identified.
Avoidance of smoking or exposure to secondhand smoke (passive smoking) is
recommended to all patients. Drinking fluids and possibly using medications to
thin the mucus are also helpful.
Specialists in speech/language pathology
(voice therapists) are trained to assist patients in behavior modification that
may help eliminate some voice disorders. Patients who have developed bad habits,
such as smoking or overuse of their voice by yelling and screaming, benefit most
from this conservative approach. The speech/language pathologist may teach
patients to alter their method of speech production to improve the sound of the
voice and to resolve problems, such as vocal nodules. When a patients' problem
is specifically related to singing, a singing teacher may help improve the
patients' singing techniques.
What can I
Do to Prevent and Treat Hoarseness?
- If you smoke, quit.
- Avoid agents that dehydrate the body, such as alcohol and caffeine.
- Avoid secondhand smoke.
- Drink plenty of water.
- Humidify your home.
- Watch your diet - avoid spicy foods.
- Try not to use your voice too long or too loudly.
- Use a microphone if possible in situations where you need to project
- Seek professional voice training.
- Avoid speaking or singing when your voice is injured or hoarse.
- Avoid speaking or singing when your voice is injured or
© 2004 AAO-HNS/AAO-HNSF
Please read our disclaimer. Any information provided on this Web site should not be considered medical advice or a substitute for a consultation with Dr. Hector N. Hernandez or other healthcare professional. If you have a medical problem, contact us for diagnosis and treatment.