What is hoarseness?
Hoarseness (dysphonia) describes a change in voice quality: the voice may sound raspy, breathy, strained or weak. Our voice is produced by the vibration of the vocal cords inside the voice box (larynx). Any condition that affects the structure or movement of the vocal cords can cause hoarseness. It is usually temporary and harmless, but hoarseness that does not resolve should always be evaluated by an ENT specialist.
What causes hoarseness?
The most common cause is inflammation of the voice box (laryngitis) accompanying colds and upper respiratory infections; it usually settles within one to two weeks. In people who use their voice intensively (teachers, call-centre workers, singers), vocal strain may over time lead to vocal cord nodules, polyps or cysts. Reflux of stomach acid reaching the throat causes hoarseness that is typically worse in the morning, together with a sensation of a lump in the throat. Smoking, allergies, low thyroid hormone levels and certain medications can also affect the voice. More rarely, vocal cord paralysis and cancer of the larynx may present with hoarseness; in smokers this possibility is investigated with particular care.
When should you see a doctor?
Hoarseness lasting longer than 3 weeks requires an ENT examination without delay — especially if it is accompanied by difficulty swallowing, shortness of breath, a neck lump, ear pain or blood-stained sputum. In smokers, persistent hoarseness must always be evaluated endoscopically.
How is it diagnosed?
During the examination the vocal cords are visualised directly with a thin camera passed through the nose or mouth (endoscopic laryngoscopy). The procedure takes a few minutes and is painless. When needed, videolaryngostroboscopy — which shows the vibration of the vocal cords in slow motion — allows detailed assessment of lesions such as nodules, polyps and cysts.
Treatment of hoarseness
Treatment depends entirely on the cause. In laryngitis due to infection, voice rest, plenty of fluids and medication where necessary are sufficient. Reflux-related hoarseness is managed with acid-suppressing treatment and dietary adjustments. The mainstay of treatment for vocal cord nodules is voice therapy; once faulty voice habits are corrected, nodules usually regress. Polyps and cysts, on the other hand, generally require microlaryngeal surgery performed under a microscope. Stopping smoking is the first step of treatment in every case.
Protecting your voice
Drink plenty of water, avoid shouting and whispering, take short voice breaks on days of heavy voice use, and stay away from smoking.
This article is for general information; please consult your physician for diagnosis and treatment.