what is hoarseness?
If you’re hoarse, your voice will sound breathy, raspy, or strained, or have a lower volume or lower pitch. his throat may feel scratchy. hoarseness is often a symptom of problems with the vocal cords in the larynx.
how does our voice work?
The sound of our voice is produced by the vibration of the vocal cords, which are two bands of smooth muscle tissue that face each other in the larynx. The larynx is located between the base of the tongue and the top of the trachea, which is the passageway to the lungs (see figure).
When we’re not talking, the vocal cords are open so we can breathe. however, when it comes time to speak, the brain orchestrates a series of events. the vocal cords come together as air from the lungs passes through, causing them to vibrate. the vibrations produce sound waves that travel through the throat, nose, and mouth, which act as resonant cavities to modulate sound. The quality of our voice – its tone, volume and pitch – is determined by the size and shape of the vocal cords and resonant cavities. That’s why people’s voices sound so different.
Individual variations in our voices are a result of how much tension we put on our vocal cords. for example, relaxing the vocal cords makes the voice deeper; tightening them makes the voice higher.
If my voice is hoarse, when should I see my doctor?
You should see your doctor if your voice has been hoarse for more than three weeks, especially if you haven’t had a cold or flu. You should also see a doctor if you are coughing up blood or have difficulty swallowing, feel a lump in your neck, experience pain when speaking or swallowing, have difficulty breathing, or lose your voice completely for more than a few days. p>
how will my doctor diagnose what is wrong?
Your doctor will ask about your health history and how long you’ve been hoarse. Depending on your symptoms and general health, your doctor may refer you to an otolaryngologist (a doctor who specializes in diseases of the ears, nose, and throat). An otolaryngologist will usually use an endoscope (a flexible, lighted tube designed to view the larynx) to get a better view of the vocal cords. In some cases, your doctor might recommend special tests to assess voice irregularities or vocal airflow.
what are some of the conditions that cause hoarseness and how are they treated?
Your doctor will ask about your health history and how long you’ve been hoarse. Depending on your symptoms and general health, your doctor may refer you to an otolaryngologist (a doctor who specializes in diseases of the ears, nose, and throat). An otolaryngologist will usually use an endoscope (a flexible, lighted tube designed to view the larynx) to get a better view of the vocal cords. In some cases, your doctor might recommend special tests to assess voice irregularities or vocal airflow.
hoarseness can have several possible causes and treatments, as described below:
Laryngitis. Laryngitis is one of the most common causes of hoarseness. It may be due to temporary swelling of the vocal cords from a cold, upper respiratory infection, or allergies. Your doctor will treat laryngitis based on its cause. if it’s due to a cold or upper respiratory infection, your doctor may recommend rest, fluids, and over-the-counter pain relievers. allergies can be treated in a similar way, with the addition of over-the-counter allergy medications.
misuse or excessive use of the voice. cheering at sporting events, speaking loudly in noisy situations, speaking too long without resting the voice, singing loudly, or speaking too loudly. high or too low can cause temporary hoarseness. resting, reducing the use of your voice, and drinking plenty of water should help relieve hoarseness caused by misuse or overuse. Sometimes people whose work depends on their voice, such as teachers, singers, or public speakers, develop a hoarseness that won’t go away. If you use your voice for a living and regularly experience hoarseness, your doctor might suggest that you see a speech-language pathologist for voice therapy. In voice therapy, you will be given vocal exercises and tips to prevent hoarseness by changing the way you use your voice.
gastroesophageal reflux (GERD). GERD, commonly called heartburn, can cause hoarseness when stomach acid rises up the throat and irritates the tissues. hoarseness caused by gerd is usually worse in the morning and improves throughout the day. In some people, stomach acid rises up the throat and larynx and irritates the vocal cords. this is called laryngopharyngeal reflux (lpr). lpr can occur during the day or at night. some people will not get heartburn with lpr but may feel like they have to constantly 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. Vocal nodules, polyps, and cysts are benign (noncancerous) growths within or along the vocal cords. Vocal nodules are sometimes called “singer’s nodules” because they are a common problem among professional singers. they form in pairs on opposite sides of the vocal cords as a result of too much pressure or friction, much like a callus forms on the foot from a shoe that is too tight. a vocal polyp usually occurs only on one side of the vocal cord. A vocal cyst is a hard mass of tissue enclosed in a sac of membrane within the vocal cord. The most common treatments for nodules, polyps, and cysts are voice rest, voice therapy, and surgery to remove the tissue.
vocal cord hemorrhage. vocal cord hemorrhage occurs when a blood vessel on the surface of the vocal cords ruptures and the tissues fill with blood. If you suddenly lose your voice during strenuous use of your voice (such as yelling), you may have a vocal cord hemorrhage. Sometimes a vocal cord bleed will cause hoarseness to develop rapidly over a short period of time and only affect your singing voice but not speaking. Vocal cord hemorrhage should be treated immediately with complete voice rest and a visit to the doctor.
vocal cord paralysis. vocal cord paralysis is a voice disorder that occurs when one or both vocal cords do not open or close properly. can be caused by head, neck, or chest injuries; lung or thyroid cancer; tumors of the skull base, neck, or chest; or infection (for example, lyme disease). People with certain neurological conditions, such as multiple sclerosis or Parkinson’s disease, or who have had a stroke, may experience vocal cord paralysis. in many cases, however, the cause is unknown. Vocal cord paralysis is treated with voice therapy and, in some cases, surgery. For more information, see the National Institute on Deafness and Other Communication Disorders (NIDCD) fact sheet, Vocal Cord Paralysis.
neurological diseases and disorders. Neurological conditions that affect the areas of the brain that control the muscles of the throat or larynx may 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 on the type of disease or disorder. For more information, read the NIDCD fact sheet, Spasmodic Dysphonia.
Other causes. Thyroid problems and injuries to the larynx can cause hoarseness. hoarseness can sometimes be a symptom of laryngeal cancer, which is why it’s so important to see your doctor if you’re hoarse for more than three weeks. read the fact sheet from the national cancer institute, version for patients with head and neck 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 airways leading from the nose and mouth to the lungs. read the nidcd fact sheet, recurrent respiratory papillomatosis or laryngeal papillomatosis.
what research is being done to better understand and treat hoarseness?
nidcd-funded researchers are working with teachers to devise strategies to help them reduce stress and tension in their voices. in one study, teachers use a voice “dosimeter” that takes into account the frequency and volume of your speech along with the duration of vibration in your vocal cords to determine your daily “dose” of vocal use. the researcher hopes to establish a safe level of voice use, as well as recommended recovery times after speaking for a long time.
In another study, researchers are working with two groups of student teachers in the United States and China to test the efficacy of voice hygiene education alone and with voice production training. the researcher hopes to see how successfully the techniques prevent future voice problems in teachers who have healthy voices at the start of the study versus those who may already have some voice problems.
nidcd is also supporting a researcher who plans to “map” all the genes, proteins, immune system cells, and bacteria present in the normal larynx so we can better understand the changes that occur during chronic disease. inflammation of the larynx (laryngitis). With these findings, models will be created that can be used in the laboratory to develop and direct future interventions for the prevention and treatment of inflammatory diseases of the larynx.
Where can I find additional information?
nidcd maintains a directory of organizations that provide information on normal and impaired hearing, balance, taste, smell, voice, speech, and language processes. Use the following keywords to help you find organizations that can answer questions and provide information about hoarseness:
- voice
- laryngology
- speech-language pathologist
