Hoarseness

Hoarseness or raspy voice is a symptom with several different causes.

• Hoarseness is an abnormal change in the voice.
• The most common cause of hoarseness is acute laryngitis.
• The underlying cause of hoarseness can usually be diagnosed by a healthcare professional based on the patient's history and physical exam.
• The treatment for hoarseness depends on the underlying cause.
• Hoarseness can be prevented by avoiding excessive strenuous voice use and smoking cessation.

Hoarseness is an abnormal change in the voice caused by a variety of conditions. The voice may have changes in pitch and volume, ranging from a deep, harsh voice to a weak, raspy voice.

While hoarseness is often a symptom of an underlying condition, unexplained hoarseness does not have an identifiable cause. This type of hoarseness can recurrent or persistent. Most often, unexplained hoarseness may be due to an underlying condition that has not yet been diagnosed.

Hoarseness is generally caused by irritation of, or injury to, the vocal cords. The larynx (also referred to as the voice box), is the portion of the respiratory (breathing) tract containing the vocal cords. The cartilaginous outer wall of the larynx is commonly referred to as the "Adam's apple." The vocal cords are two bands of muscle that form a "V" inside the larynx. When we sing or speak, the vocal cords vibrate and produce sound.

Picture of the Larynx

Hoarseness can be caused by several conditions. The most common cause of hoarseness is acute laryngitis (inflammation of the vocal cords) caused most often by an upper respiratory tract infection (usually viral), and less commonly from overuse or misuse of the voice (such as from yelling or singing).

Other causes of hoarseness include:

• benign vocal cord nodules, cysts or polyps,
• vocal cord paralysis
• gastroesophageal reflux (GERD),
• allergies,
• inhalation of respiratory tract irritants,
• smoking,
• thyroid problems,
• trauma to the larynx/vocal cords,
• neurological conditions (such as Parkinson's disease and strokes), and
• cancer of the larynx.

Hoarseness typically gives the voice a raspy and harsh quality, though it may also cause a change in the pitch or volume of the voice. The rapidity of onset and any associated symptoms will depend on the underlying cause leading to hoarseness.

A healthcare professional will ask the patient questions about their hoarseness and any other associated symptoms. A physical exam will focus on the head and neck. Oftentimes, a diagnosis can be made based on this initial assessment. In some instances, a long lighted flexible tube (fiberoptic scope) will be inserted into the throat to directly visualize the vocal cords if no other cause is initially identified. Individuals with hoarseness that lasts longer than 2 to 3 weeks should have a consultation with an otolaryngologist to exclude any serious causes of hoarseness.

The treatment for hoarseness depends on the underlying cause, for example:

• Acute laryngitis caused by an upper respiratory tract infection will usually improve on its own as the infection clears the body. Conservative treatment with cough suppressants and humidified air can be helpful.
• Voice rest is also recommended to avoid further irritation or injury to the vocal cords.
• Antibiotics are not indicated for most cases of acute laryngitis.
• Smoking cessation is suggested for those individuals that smoke.
• Individuals with hoarseness caused by vocal overuse or misuse should adhere to voice rest, as serious injury (such as vocal cord hemorrhage can occur to the vocal cords if the voice is strenuously used during episodes of acute laryngitis.
• Medications for gastroesophageal reflux (GERD) or allergies can treat hoarseness if either of these is found to be the underlying cause.
• In some instances, surgery may be necessary for benign nodules or polyps, trauma to the larynx/vocal cords, and cancer of the larynx.

Hoarseness can be prevented in some instances, for example:

• Avoid situations that require excessive strenuous voice use, and if a person needs to project their voice, use a microphone if possible.
• Voice therapists or singing teachers may be helpful in certain cases to assist individuals with vocal training and voice modification.
• Smoking cessation can prevent hoarseness or the development of cancer of the larynx.
• Individuals with hoarseness caused by gastroesophageal reflux (GERD) can benefit from medications and dietary modification (such as avoiding alcohol, caffeine, and spicy foods).

Because hoarseness may be a symptom of a serious underlying condition, it shouldn't be ignored. Some of the serious conditions hoarseness may be associated with include:

• Vocal cord cancer
• Thyroid cancer
• Laryngeal cancer
• Neurological disorders
• Acid reflux

If your hoarseness persists for longer than two weeks or if it is accompanied by other symptoms, consult your healthcare provider.