Hoarseness means a change in the quality of the voice. The voice may sound rough, weak, breathy, strained, or lower than usual.
Common causes include voice overuse, viral infections, irritation from smoking or vaping, reflux, and vocal-fold problems.
How is it diagnosed?
Diagnosis is based on your symptoms and examination. When hoarseness is persistent, examining the larynx with an endoscope is an important part of the evaluation, because it allows the vocal cords to be seen and helps identify the cause.
Treatment
Treatment depends on the cause of the hoarseness, so there is no single treatment that is appropriate for everyone. Depending on the findings, it may include addressing inflammation or reflux when present, changing how the voice is used, voice therapy, or other treatment directed at the underlying cause.
What can help?
- Drink plenty of water.
- Avoid shouting, prolonged loud talking, and repeated throat clearing.
- Rest the voice when it feels strained.
- Use amplification if you need to speak to large groups.
- Avoid smoking and vaping.
- Treat nasal congestion or reflux when they are clearly contributing. Reflux treatment is not a substitute for examining the voice box when hoarseness persists.
- Avoid whispering for prolonged periods, as it can also strain the voice.
Throat clearing
Frequent throat clearing can irritate the vocal cords and create a cycle of further irritation.
Instead, try:
- Taking a sip of water
- Swallowing
- A gentle cough only when needed
When should hoarseness be assessed?
Arrange an ENT assessment if:
- Hoarseness does not improve within 4 weeks
- The voice is progressively worsening
- There is persistent pain with speaking
- There is persistent difficulty or pain with swallowing
- There is coughing up blood
- There is a neck lump
- There is unexplained weight loss
- You smoke or have a significant smoking history
- You have had recent intubation, or recent surgery on the head, neck, or chest
- Your voice is important for your profession and symptoms are persistent
Seek urgent assessment if hoarseness is associated with significant difficulty breathing.
Important: Persistent hoarseness can have many causes. Hoarseness that does not improve within four weeks should be assessed with examination of the voice box, and sooner if any of the features above are present.