Hoarseness is a change in the voice. It can sound breathy, rough, strained, quieter, or higher or lower than usual.
How the voice is made
The vocal folds sit in the voice box. They stay apart while you breathe. They meet and vibrate as air leaves the lungs, and that vibration is the sound. Tighter, smaller folds vibrate faster and make a higher pitch. Swelling or a lump keeps them from meeting cleanly, so the voice changes.
Common causes
Most hoarseness is short-lived. A cold, a viral upper respiratory infection, or one loud night (a game, a concert) swells the folds. That is acute laryngitis.
Voice use that is too long, too loud, or poorly supported can leave callus-like nodules or fuller swelling called polyps. Children and adults who shout at work or at play get these. Nodules and polyps are usually benign. Cancer is uncommon, and it is one reason a voice that stays hoarse gets looked at.
Stomach acid can reach the folds without heartburn. The voice is often worse in the morning and better later. People describe a lump, sticky mucus, or a constant need to clear the throat. Smoking is another cause, and it is the main risk for throat cancer, so a smoker with hoarseness should be seen. Allergies, thyroid disease, nerve problems, injury, the menstrual cycle, and age can change the voice too.
When to be seen
Come in if hoarseness lasts longer than two or three weeks, or sooner if you also have:
- Pain that is not from a cold
- Blood when you cough
- Trouble swallowing
- A lump in the neck
- A voice that is gone, or severely changed, for more than a few days
An ENT looks at the folds with a mirror or a thin scope through the nose or mouth. The exam is brief. Sometimes we record it, or measure how the voice sounds and how air moves, so treatment matches the problem.
What helps a mild case
Treatment follows the cause. Many people improve with voice rest and a change in how they speak. A speech-language pathologist can retrain habits that produced nodules. A singing teacher helps when the problem shows up in singing. Surgery is reserved for a defined lesion that does not settle.
While a mild voice is healing:
- Stop smoking, and stay out of secondhand smoke
- Drink water, and humidify dry indoor air
- Cut back on alcohol, caffeine, and spicy food if reflux is part of the picture
- Do not push a long or loud voice
- Do not sing or project on a voice that is already injured
Day-to-day voice rest is covered in how to rest a strained voice. Voice problems are part of our ear, nose, and throat care.
