What can cause a hoarse voice and how is it treated?

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The National Institute on Deafness and Other Communication Disorders (NICDC) note that hoarseness refers to a voice that sounds raspy or strained with a lower pitch or softer volume. It can indicate an issue with the vocal cords or throat.

Hoarseness may be a sign of inflammation in the larynx, known as laryngitis. The larynx, also called the voice box, sits at the top of the throat and contains the vocal cords.

The vocal cords are two bands of cartilage and muscle that vibrate when a person speaks or eats. The size and shape of the vocal folds determine how a voice sounds.

Swelling or irritation of the vocal cords can limit the usual vibrational movement, leading to a person’s voice becoming hoarse.

There can be several causes of a hoarse voice, including the below.

Laryngitis

Laryngitis is one of the most common causes of a hoarse voice, and the condition can be acute or chronic. Acute laryngitis is usually due to an infection of the upper respiratory tract, such as the flu.

It can also occur due to overusing the voice, for example:

• shouting
• speaking loudly
• singing loudly
• talking for too long without rest
• speaking in a voice that is too low or too high

Healthcare professionals define laryngitis as chronic if it persists beyond 3 weeks.

Possible causes of chronic laryngitis include:

• smoking
• excessive alcohol use
• gastroesophageal reflux disease (GERD)
• exposure to chemicals or dust that irritate the larynx

Vocal nodules, cysts, and polyps

Vocal nodules, cysts, and polyps are benign growths that can appear along the vocal folds.

• Vocal nodules, or singer’s nodes, grow in pairs on the opposite sides of a person’s vocal cords. This can result in too much pressure or friction.
• A vocal cyst is a hard growth of tissue that occurs inside the vocal cord.
• Vocal polyps typically occur on one side of the vocal fold.

Treatments usually involve rest, surgery, or voice therapy.

Vocal fold hemorrhage

A vocal fold hemorrhage occurs when a blood vessel on the surface of a person’s vocal fold ruptures. They may experience a hoarse voice quickly, which can affect their singing voice.

If this occurs, a person should rest their voice immediately and contact a doctor.

Vocal cord paralysis

Vocal cord paralysis occurs when one or both vocal folds fail to open or close properly. This can be due to:

• injury to the head, chest, or neck
• tumors in the base of the skull, neck, and chest
• lung cancer
• thyroid cancer

Treatments involve voice therapy, and in some cases, surgery.

Neurological conditions

Some neurological conditions can affect the parts of the brain that control the throat and larynx muscles.

These may include:

• stroke
• Parkinson’s disease
• spasmodic dysphonia

Acid reflux or GERD

Acid reflux occurs when stomach acid rises and irritates the throat. In some people, it can damage the larynx. Healthcare professionals refer to this as laryngopharyngeal reflux (LPR).

GERD is a severe form of acid reflex. If a person has GERD, they may notice a hoarse voice that is worse in the morning.

People with LPR may feel as if they have to clear their throat constantly.

Treatments include dietary changes and medications.

The indicators of a hoarse voice include a low, raspy voice. It can occur with other symptoms, depending on the underlying cause.

According to the Voice Foundation, other possible symptoms with a hoarse voice include:

• the sensation of a lump in the throat
• a dry feeling throat
• constantly needing to clear the throat
• persistent cough
• postnasal drip
• difficulty swallowing
• sore throat
• mucus in the throat

Some symptoms might indicate a specific cause. For example, a bitter or sour taste in the mouth and worsening symptoms after consuming spicy foods may indicate GERD.

Treatments for a hoarse voice depend on the cause.

In some cases, resting the voice and drinking plenty of water will help the larynx recover. However, more persistent causes may require medical treatment.

Health experts note that a person may benefit from a speech and language therapist. This approach can help people avoid using the voice in a way that irritates the vocal cords, which may prevent further irritation.

If a hoarse voice is due to smoking or exposure to chemicals that irritate the larynx, a doctor will recommend avoiding these triggers. Not consuming excessive alcohol may also help.

If a viral infection is responsible for a hoarse voice, the symptoms may go away on their own. Doctors sometimes use antiviral medications to help with symptoms and shorten the recovery time by 1–2 days.

GERD is treatable with lifestyle changes, including:

• maintaining a moderate weight
• quitting smoking
• avoiding spicy, greasy, or acidic foods

Doctors may also suggest antacids to treat the symptoms of GERD.

The NIDCD note that a hoarse voice is not always a cause for concern. For example, some people may experience the condition after excessively using their voice, such as shouting or singing. In these cases, a hoarse voice is usually temporary.

A person should contact a doctor if they experience a hoarse voice that lasts longer than 3 weeks. This is particularly important if they do not have cold or flu symptoms.

Contact a doctor immediately if any of the following symptoms occur:

• coughing up blood
• a lump develops in the neck
• pain when speaking or swallowing
• difficulty breathing
• complete loss of voice for a few days

A doctor will first ask about symptoms and lifestyle habits, such as smoking and drinking, to try and identify the cause. They might also want to know about the nature of a person’s work or recent operations.

A healthcare professional may perform physical examinations of the mouth and throat. For example, they might use a mirror to inspect the larynx and check for inflammation or irritation.

Identifying and avoiding triggers can help prevent a hoarse voice. For some people, this could be how they use their voice.

To help prevent a hoarse voice, people should:

• drink plenty of water
• use a humidifier in the home
• wash hands often to reduce chances of contracting a cold or flu
• rest the voice when ill
• exercise regularly
• practice breathing techniques when talking or singing

In addition, people should avoid:

• smoking
• consuming spicy foods, particularly if they experience acid reflux
• using mouthwash containing alcohol
• overusing the voice where possible

There can be multiple reasons for a hoarse voice, including laryngitis or vocal nodules. The main symptom is typically a low, raspy voice. However, depending on the cause, other symptoms can emerge, such as a cough or sore throat.

Hoarseness is not always a cause for concern. Often, a person’s voice will return to normal without treatment. In other cases, doctors might suggest medications or lifestyle changes to treat the condition.