Hoarseness describes a voice change from your normal voice to a raspy, breathy, cracking or rough sounding voice. There are many causes of hoarseness; the most common being acute laryngitis from an upper respiratory infection and improper voice use from shouting or cheering.
When should you be concerned about a hoarse voice?
There are many associated symptoms relating hoarseness that help distinguish whether voice changes are harmless and will go away or whether they are a sign of a bigger issue. For instance, someone whose voice is hoarse after a viral upper respiratory tract infection is obviously less concerning then a long-time smoker who is also coughing up blood.
The best recommendation for anyone experiencing hoarseness is to seek medical attention from an ENT specialist or PCP. Any hoarseness persisting over 4 weeks that has not yet been evaluated by an ENT specialist, should be evaluated further with an endoscopic evaluation of your larynx.
Common causes of hoarseness or hoarse voice
The larynx is the voice box and is located in the lower middle part of the neck under the Adam’s apple. The vocal cords are within the voice box and are what vibrate to make speech. If they become irritated or irregular, the voice will become abnormal or hoarse. This can occur with infection as in an upper respiratory infection, trauma as in shouting at a sporting event or anything that irritates or changes the surface of the vocal cords including a growth.
How do you get laryngitis?
Laryngitis from infection is usually viral and clears once the infection has cleared. That’s an example of acute laryngitis. If the vocal cords are irritated and swollen from acid reflux or voice abuse, the hoarseness will persist until those issues are resolved. That would be an example of chronic laryngitis defined as hoarseness lasting more than 6 weeks.
Hoarseness that persists may be an early sign of a growth on the vocal cords and should not be ignored. These growths may be cancerous or benign. Hoarseness lasting more than 4 weeks should prompt a visit to an ear, nose and throat doctor. If you have difficulty breathing along with hoarseness, you should see a doctor immediately. Difficulty swallowing may occur with laryngitis as part of an infection or growth and also needs to be evaluated soon.
Diagnosing and treating laryngitis
An ear, nose and throat doctor can examine your voice box using a small tool called a fiber optic endoscope. This procedure usually lasts only a few minutes and can be done in the office. If a growth is found, the doctor will want a biopsy. This can be done with you asleep under general anesthesia. If the vocal cords are irritated from shouting, voice rest may be needed or even speech therapy. Acute laryngitis, if viral, just needs time to resolve by itself, much as a cold would. Antibiotics are not useful for viral infections including laryngitis.
How To Know If Hoarseness Is A Sign of Something Serious
There are many associated symptoms relating to one’s hoarseness that help distinguish whether voice changes are harmless and will go away or whether they are a sign of a bigger issue. Someone whose voice is hoarse after a viral upper respiratory tract infection is obviously less concerning than a long-time smoker who is also coughing up blood. The best recommendation for all who are hoarse is to seek medical attention. This can be done with an ear, nose and throat specialist.
If you do not see an ear, nose and throat specialist first, then we recommend following a simple four-week rule: If your hoarseness persists beyond four weeks, then you should see an otolaryngologist to have an endoscopic evaluation of your larynx (a.k.a. “voice-box”). The most widely used method of examining the larynx and vocal folds is via an endoscope (this is very small, measuring less than 4mm in diameter). It is inserted through one nostril and guided through the nose to the back of the throat, until it lies just above the larynx. With the endoscope the doctor can examine the larynx during a variety of tasks – such as swallowing, speaking, and singing. This will help determine the cause of your voice disorder and an appropriate management plan.
Treatment plans vary widely based on the source of hoarseness. For most benign conditions, supportive measures are most effective, and often the only thing needed. These measures include partial or complete voice rest, air humidification, oral hydration, and most importantly, avoiding extreme use of your voice like yelling. Other times, persistent hoarseness requires surgery for improvement.
Hoarseness describes a voice change from your normal voice to a raspy, breathy, cracking or rough sounding voice. There are many causes of hoarseness. Probably the most common cause is acute laryngitis as part of an upper respiratory infection. Improper voice use is another common cause. Something as simple as shouting at your child’s baseball game or trying to have a conversation at a noisy party could irritate your vocal cords enough to cause hoarseness.
Vocal cord nodules and polyps are non-cancerous growths that can form on vocal cords from vocal abuse. Vocal cord nodules are tiny bumps like calluses that may form on vocal cords. They are sometimes called screamer’s nodes, teacher’s nodes or singer’s nodes. These names indicate the type of individual most likely to develop nodules due to voice abuse. Vocal cord polyps are more fleshy and usually larger growths. They also form from voice abuse. Smoking may cause vocal polyps as well.
Acid reflux, if it goes high enough in the esophagus to reach the back of the voice box is another common cause of hoarseness. The reflux irritates the back of the voice box causing swelling that may interfere with normal vocal cord movement.
Cancer of the larynx (voice box) is a less common but far more serious cause. Throat cancer is usually found in drinkers and smokers. Cancer of the larynx, if caught early is very curable. Since hoarseness occurs early on in the disease it’s very important to have it evaluated quickly.
Determining the cause of hoarseness involves looking at the voice box with an endoscope, which is a small telescope, or mirror in the office. This is a very simple and quick procedure done by ear, nose and throat doctors. If hoarseness persists for more than a week or two, medical evaluation is needed. Treatment will depend on the diagnosis. Voice rest, speech therapy, certain medications and surgical removal are treatment options for benign disease. If cancer is suspected, a biopsy, usually under anesthesia, would be a likely next step.