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Hoarseness

What Does It Mean if I Experience Hoarseness?

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Updated May 16, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Doctor examining female patient
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In addition to interfering with speech, the symptom of hoarseness may have you concerned that something is wrong with your body. What exactly is hoarseness, what are some possible causes and when should you see your doctor?

What Is Hoarseness?

Hoarseness is defined as an abnormal sound when you try to speak. This may be described as raspy, breathy, soft, tremulous or as changes in the volume of your voice. You may also experience pain or a strained feeling when trying to speak normally.

A hoarse voice can be caused by anything that interferes with the normal vibration of the vocal cords, such as swelling and inflammation, polyps that get in the way of the vocal cords closing properly or conditions that result in one or both of the vocal cords becoming paralyzed. Hoarseness is also referred to by the medical term "dysphonia."

When Should You See Your Doctor?

It’s important to see your doctor if you are experiencing hoarseness that lasts beyond a few days. While most causes of hoarseness are benign and are due to transient causes such as a cold, it may also be a symptom of something more serious. If your symptom persists it’s important to make an appointment with a doctor – even if you think there's a reasonable cause. Doctors vary on what they call "persistent." In general, if your symptoms last more than two weeks, progressively worsen or are associated with other symptoms, you should make an appointment.

If you notice the sudden loss of voice or have other concerning symptoms, such as weakness in a part of your body, visual changes or lightheadedness, call your doctor or 911 immediately.

What are Some Questions Your Doctor May Ask?

When you visit your doctor, she will first take a careful history. Some of the questions she may ask include:
  • When did your symptoms begin?

  • Is your hoarseness continuous or do you notice it on and off?

  • Have you had any symptoms of a "head cold," such as a runny nose, fever or cough, or have you had an illness such as tonsillitis or mononucleosis?

  • Have you strained your voice in any way, for example by cheering for your favorite football team or singing too long or too loudly?

  • Do you, or have you ever, smoked?

  • Do you drink alcohol?

  • Do you have allergies or eczema?

  • What other medical conditions do you have?

  • Have you experienced any heartburn, unexplained weight loss, persistent cough, coughing up blood, difficulty swallowing, weakness in any part of your body or felt a lump in your neck?

  • What medical conditions run in your family?

Possible Causes

Hoarseness is a common symptom that most people have experienced from time to time while fighting a cold or the flu. But it can also be a symptom of something more serious. Some possible causes include:
  • Layrngitis - Laryngitis is the most common cause of hoarseness and can be caused by several things, ranging from the common cold, to cheering a bit too loudly or long at a ball game, to singing your heart out at a concert.

  • Vocal cord cysts or polyps - Vocal cord cysts are essentially "lumps" on your vocal cords that interfere with their normal closing during speaking. They usually result from overuse of your voice. They can be seen as similar to the calluses people develop on their hands with overuse, such as after raking a yard in the fall. Singers, teachers and other professionals who use their voices a lot can get polyps.

  • Allergies - Both seasonal and year-round allergies can result in hoarseness.

  • Acid reflux/Heartburn - Gastroesophageal reflux (GERD), the reflux of acid from the stomach up to the vocal cords, is a fairly common cause of hoarseness, and many people are unaware of its presence because it's not always associated with heartburn. Hoarseness due to acid reflux is usually worse in the morning.

  • Thyroid conditions – Thyroid conditions, especially untreated hypothyroidism (low thyroid), can cause hoarseness.

  • Smoking - Secondhand smoke exposure may also result in a hoarse voice.

  • Exposure to other irritating substances - Irritants, ranging from air pollution to chemicals we use in our homes, can cause hoarseness.

  • Long-term use of inhaled corticosteroids - Inhaled corticosteroids, a category of inhalers used chronically for asthma or COPD can result in a hoarse voice.

  • Cancer – Cancers of the larynx (the windpipe), the pharynx (the throat), the lungs, the thyroid and lymphomas may all have hoarseness as a symptom. Sometimes hoarseness is the first symptom. Metastatic cancer (cancer that has spread) from the breast, lungs or other regions of the body to the mediastinum (the area between the lungs), can press on nerves leading to the voice box and cause hoarseness.

  • Neurological conditions - Strokes, Parkinson’s disease and multiple sclerosis may all cause hoarseness due to their effects on the nerves supplying the vocal cords.

  • Trauma – Blunt trauma to the throat region, for example during a motor vehicle accident may damage the vocal cords. A more common cause of trauma occurs when the vocal cords are damaged by a tube that is placed (intubation) down the throat during surgery, during a bronchoscopy or when a person is having difficulty breathing and requires intubation.

  • Spasmodic dysphonia - Spasmodic dysphonia is a local problem with the muscles of the larynx, resulting in hoarseness.

  • Larnygeal nerve paralysis - The nerves leading to the voice box may be damaged by any surgery in the region where a nerve travels, such as thyroid surgery, heart surgery or head and neck surgeries.

  • Inhalation of a foreign body or caustic substance.

Tests to Look for the Cause of Hoarseness

If your symptoms are persisting and your doctor does not find an obvious cause after examining your ears, nose and throat, she may order further tests. Some of these include:
  • Blood tests – To look for infection.

  • Laryngoscopy - A larygnoscopy is a test in which doctors use a flexible tube with a light attached to look down your nose at your vocal cords. A numbing medication is applied to the back of your throat before this is done, and people usually have little discomfort.

  • CT scan (or other imaging studies) - To look at your neck and chest.

  • Other tests - Depending on your specific situation.

Treatment

Treating your hoarseness will depend on the underlying cause. Your doctor may recommend medications to soothe your throat. For most causes of hoarseness, resting your body and voice for a few days will suffice.

If your voice is strained or if you develop vocal polyps, a longer period of voice rest may be recommended. Some of you have heard of your favorite singer needing to cancel his tour to take a break for a few months. This may be the case for amateur singers as well and overly enthusiastic sports fans.

If you smoke, it’s very important to quit – both to help with healing now and to prevent problems in the future.

For those whose problems persist, voice therapy can be very helpful to reduce damage while restoring your voice to health.

Further Reading:

Sources:

Barry, D., and M. Vaezi. Laryngopharyngeal reflux: More questions than answers. Cleveland Clinic Journal of Medicine. 2010. 77(5):327-34.

Feierabend, R., and M. Shahram. Hoarseness in adults. American Family Physician> 2009. 80(4):363-70.

Mau, T. Diagnostic evaluation and management of hoarseness. The Medical Clinics of North America. 2010. 94(5_945-60.

National Institute of Health. MedlinePlus. Hoarseness. Updated 11/23/10. http://www.nlm.nih.gov/medlineplus/ency/article/003054.htm

Schwartz, S. et al. Clinical practice guideline: hoarseness (dysphonia). Otolaryngology – Head and Neck Surgery. 2009. 141(3Suppl 2):S1-S31.

Syed, I., Daniels, E., and N. Bleach. Hoarse voice in adults: an evidence-based approach to the 12 minute consultation. Clinical Otolaryngology. 2009. 34(1):54-8.

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