Abnormal changes in the voice are called hoarseness. When hoarse, the voice may sound breathy, raspy, strained, or show changes in volume or pitch (depending on how high or low the voice is). Voice changes are related to disorders in the sound-producing parts (vocal folds) of the voice box (larynx). While breathing, the vocal folds remain apart. When speaking or singing, they come together and, as air leaves the lungs, they vibrate, producing sound. Swelling, inflammation, nodules, or other issues with the vocal folds hinder vibration, altering voice quality, volume, and pitch.
The most common cause of hoarseness is a cold or sinus infection, which most often goes away on its own within 2 weeks. Other common causes are vocal abuse (over use or straining the voice), gastroesophageal reflux disease (GERD) and advancing age. Rarely, when hoarseness does not go away, the causes can be more serious such as vocal cord nodules, polyps, granulomas, paralysis (immobility), and cancer. Unexplained hoarseness lasting more than three weeks should usually be evaluated by an ear, nose and throat (ENT) specialist
The voice box and surrounding tissue will then be examined typically using a laryngoscope (a small lighted flexible instrument placed in the back of your throat through your nose).
Voice quality can indicate different underlying causes. A breathy voice may suggest poor vocal cord function, which may be caused by a benign (non-cancerous) tumor, polyp or larynx cancer.
A raspy voice may indicate vocal cord thickening due to swelling, inflammation from infection, a chemical irritant, voice abuse or paralysis of the vocal chords.
A high, shaky voice or a soft voice may suggest trouble getting enough breathing force or air.
Tests, such as a biopsy, x-rays, or thyroid function may be ordered depending on the findings of the physical exam.
Treatment varies depending on the condition causing the hoarseness.
Hoarseness can have several possible causes and treatments.
Laryngitis is one of the most common causes of hoarseness. It can be due to temporary swelling of the vocal folds from a cold, an upper respiratory infection, or allergies. Your doctor will treat laryngitis according to its cause. If it's due to a cold or upper respiratory infection, your doctor might recommend rest, fluids, and nonprescription pain relievers. Allergies might be treated similarly, with the addition of over-the-counter allergy medicines.
Straining or overusing your voice, for example by shouting or singing or talking for too long without resting your voice, can cause temporary hoarseness. Resting, not using your voice, and drinking lots of water normally relieve hoarseness from misuse or overuse. If you need to use your voice, for example to teach or perform, and you regularly experience hoarseness, your doctor might suggest seeing a speechlanguage pathologist for voice therapy
Gastroesophageal reflux (GERD) —commonly called heartburn—can cause hoarseness when stomach acid rises up the throat and irritates the tissues. Usually hoarseness caused by GERD is worse in the morning and improves throughout the day. Laryngopharyngeal reflux (LPR) occurs when stomach acid rises all the way up to the throat and larynx and irritates the vocal folds. LPR can happen during the day or night. Some people have no heartburn with LPR, but may feel as if they constantly have to cough to clear their throat and may become hoarse. GERD and LPR are treated with dietary modifications and medications that reduce stomach acid.
Vocal nodules, polyps, and cysts are benign (noncancerous) growths within or along the vocal folds. Vocal nodules are sometimes called "singer's nodes" because they are a frequent problem among professional singers. They form in pairs on opposite sides of the vocal folds as the result of too much pressure or friction. A vocal polyp typically occurs only on one side of the vocal fold. A vocal cyst is a mass of tissue encased in a membranous sac inside the vocal fold. The most common treatments for nodules, polyps, and cysts are voice rest, voice therapy, and surgery to remove the growth.
Vocal fold hemorrhage occurs when a blood vessel on the surface of the vocal fold ruptures and the tissues fill with blood. Sudden loss of voice during strenuous vocal use (such as yelling), may indicate a vocal fold hemorrhage. Sometimes a vocal fold hemorrhage will affect only your singing but not your speaking voice. Vocal fold hemorrhage must be treated immediately with total voice rest and medical attention.
Vocal fold paralysis occurs when one or both of the vocal folds don't open or close properly. It can be caused by injury to the head, neck or chest; lung or thyroid cancer; tumors of the skull base, neck, or chest; infection. Certain neurologic conditions such as multiple sclerosis, Parkinson's disease or a stroke may cause vocal fold paralysis. In many cases, however, the cause is unknown. Vocal fold paralysis is treated with voice therapy and, in some cases, surgery.
Neurological diseases and disorders that affect areas of the brain that control muscles in the throat or larynx can also cause hoarseness. Hoarseness is sometimes a symptom of Parkinson's disease or a stroke. Spasmodic dysphonia is a rare neurological disease that causes hoarseness and can also affect breathing. Treatment in these cases will depend upon the type of disease or disorder.
Other causes of hoarseness include thyroid problems and injury to the larynx. Hoarseness can sometimes be a symptom of laryngeal cancer. Hoarseness is also the most common symptom of a disease called recurrent respiratory papillomatosis (RRP), or laryngeal papillomatosis, which causes noncancerous tumors to grow in the larynx and other air passages leading from the nose and mouth into the lungs. Because causes of hoarseness range from simple to serious it is important to be evaluated by an ear, nose and throat specialist if you are hoarse for more than three weeks.