Hoarseness: What It Is, Symptoms, Diagnosis, and Treatment

The ability to speak is made possible by the coordination of the vocal cords and the larynx.

Speech occurs when the vocal cords and the larynx work together. The larynx is located above the trachea. The vocal cords, made up of two muscle bands, are found inside the larynx and are attached to the largest cartilage of the larynx, known as the Adam's apple. When you speak, air from the lungs reaches the mouth with the help of the trachea. As the air passes through the trachea, it causes the vocal cords inside the larynx to vibrate, and this is how sound is produced.

Some people's voices are thicker or thinner. The thickness of the voice is related to the length of the vocal cords. When the vocal cords are relaxed, they shorten, which can result in a thicker voice, or the opposite may occur. Under normal conditions, the vocal cords vibrate symmetrically. This ensures that the resulting sound is heard clearly, rather than being muffled or raspy. However, in some cases, the vocal cords may not close fully or vibrate symmetrically, which leads to hoarseness.

What Is Hoarseness?

Hoarseness is when your voice sounds raspy or breathless, as if you are out of breath. It occurs differently from a change in volume or pitch. There can be multiple reasons for hoarseness, but most are not serious and resolve on their own after a short period. It is often caused by an issue with the vocal cords. Incorrect or excessive use of the voice, as well as growths such as polyps and nodules, are factors that can cause hoarseness. A common symptom during hoarseness is an itchy feeling in the throat.

What Are the Symptoms of Hoarseness?

In addition to some obvious symptoms, hoarseness may also present with lesser-known or less common signs. The underlying cause of hoarseness may result in different symptoms appearing. Commonly observed symptoms of hoarseness include:

• Abnormally weak, breathy, or rough voice
• Changes in pitch (either higher or lower)
• Difficulty using the voice, or quick fatigue when speaking
• Sore throat
• Coughing
• Swelling in the throat area
• Difficulty swallowing

Hoarseness can also be a symptom of certain illnesses. One such condition is lung cancer. Having any cancer symptoms does not necessarily mean you have cancer, but if you have persistent hoarseness that lasts for a long time, it is advisable to see a doctor just to be s

What Are the Causes of Hoarseness?

Hoarseness is a health issue that can affect anyone, regardless of age. You can experience hoarseness at 60 years old or 15 years old. It is commonly seen in people who smoke or those who use their voice professionally or frequently. The causes of hoarseness include:

• Excessive use of the voice, such as talking for long periods, shouting, or singing for extended periods
• Common cold
• Swelling of the vocal cords due to illness or allergies
• Laryngopharyngeal reflux (a condition where stomach acid from gastroesophageal reflux reaches the throat and damages the vocal cords)
• Vocal cord hemorrhage (bleeding in the blood vessels on the vocal cords)
• Vocal cord paralysis (when one or both vocal cords are unable to move)
• Neurological diseases or disorders affecting the laryngeal muscles
• Polyps, cysts, or vocal nodules
• Laryngeal cancer
• Recurrent respiratory papillomatosis
• Muscle tension dysphonia (excessive strain on the vocal cords)

How Does Hoarseness Occur?

Hoarseness is a common problem that many people experience. Typically, one-third of people will experience hoarseness at some point in their lives. Hoarseness occurs as a result of an issue with the vocal cords. However, vocal cords do not develop issues spontaneously. A swollen nodule, cyst, or polyp can damage the vocal cords. Similarly, speaking for long periods outside your normal vocal range (either too high or too low) can strain the vocal cords, leading to fatigue and interfering with their synchronized movement. If you experience any of the following situations, you may need to consult a doctor:

• If hoarseness is not caused by a cold or flu,
• If hoarseness lasts for more than three weeks,
• If you have difficulty swallowing,
• If you cough up blood,
• If you have difficulty breathing,
• If you feel a lump in your neck,
• If your voice completely disappears within a few days.

How Is Hoarseness Diagnosed?

The best evaluation for hoarseness is done by an ear, nose, and throat (ENT) specialist or a speech pathologist. When you visit the doctor, they will first take a medical history. During this process, they may ask about any illnesses or medications you are currently taking. Common questions include:

• Duration of the problem
• Whether it developed suddenly or gradually
• Smoking habits and duration
• Presence of additional symptoms
• A history of respiratory infections
• Alcohol consumption habits

Next, the doctor will perform a physical examination, which may include the following:

• Listening to the voice or back
• Checking for any lumps in the head or neck area
• Laryngoscopy: Using a small camera inserted through the nostrils to examine the throat and larynx
• Rigid laryngoscopy: Performed under anesthesia for patients who cannot tolerate flexible laryngoscopy
• Laryngeal stroboscopy: Using a flash scope to view the movement of the vocal cords while speaking, checking their synchronization

If the doctor suspects an issue, they may recommend further diagnostic tests such as a computed tomography (CT) scan or magnetic resonance imaging (MRI).

What Are the Treatment Options for Hoarseness?

Treatment options for hoarseness vary and depend on the underlying cause. Regardless of the cause, the first thing that will likely help is to avoid overusing your voice. While speaking in a hoarse voice might seem like a solution for some, speaking in a pitch higher or lower than your normal range can also strain your voice. Therefore, trying to speak as little as possible for a period may be the best option. Other general treatment options for hoarseness may include:

• For hoarseness caused by a cold or flu, treating the illness will usually help improve the voice. Your doctor will prescribe the necessary medications.
• For hoarseness caused by laryngitis, prescribed antibiotics or corticosteroids can resolve the issue.
• In gastroesophageal reflux disease (GERD), the stomach acid that reaches the throat damages the vocal cords. Treating GERD with antacids or proton pump inhibitors will help alleviate hoarseness.
• Hoarseness due to neurological causes may require more specific and different treatments.
• For hoarseness caused by nodules, cysts, or polyps, or muscle tension dysphonia, working with a speech therapist can be beneficial. Surgical treatment may be necessary depending on the condition.
• In cases of cancer, radiation therapy, chemotherapy, or other appropriate cancer treatments may be applied.
• For vocal cord paralysis, a simple procedure to move the vocal cord toward the center or more complex surgical treatment may be necessary. Your ENT specialist will provide guidance.

Hoarseness is usually not a serious problem and often resolves quickly. During this time, resting your voice as much as possible is the easiest treatment you can apply. Additionally, to prevent hoarseness or speed up the recovery process, you should quit smoking, drink plenty of water, avoid or moderately consume fluids that can dehydrate the body (such as alcohol and caffeine), and refrain from using your voice for long periods or at high volumes.