What Is Hoarseness?

Hoarseness is a general term that describes abnormal voice changes. When hoarse, the voice may sound breathy, raspy, strained, or there may be changes in volume (loudness) or pitch (how high or low the voice is). The changes in sound are usually due to disorders related to the vocal cords that are the sound producing parts of the voice box (larynx). While breathing, the vocal cords remain apart. When speaking or singing, they come together, and as air leaves the lungs, they vibrate, producing sound. Swelling or lumps on the vocal cords prevent them from coming together properly and change the way the cords vibrate, which makes a change in the voice, altering quality, volume, and pitch.


What Are The Causes Of Hoarseness?

Acute Laryngitis: There are many causes of hoarseness. Fortunately, most are not serious and tend to go away in a short period of time. The most common cause is acute laryngitis, which usually occurs due to swelling from a common cold, upper respiratory tract viral infection, or irritation caused by excessive voice use such as screaming at a sporting event or rock concert.

Vocal Nodules: More prolonged hoarseness is usually due to using your voice either too much, too loudly, or improperly over extended periods of time. These habits can lead to vocal nodules (singers’ nodes), which are callous-like growths or may lead to polyps of the vocal cords (more extensive swelling). Both of these conditions are benign. Vocal nodules are common in children and adults who raise their voice in work or play.

Gastroesophageal Reflux: A common cause of hoarseness is gastro-esophageal reflux when stomach acid comes up the swallowing tube (esophagus) and irritates the vocal cords. Many patients with reflux-related changes of voice do not have symptoms of heartburn. Usually, the voice is worse in the morning and improves during the day. These people may have a sensation of a lump in their throat, mucus sticking in their throat or an excessive desire to clear their throat. It is very important to realize that this condition is usually seen in the absence of any other symptoms, although patients are almost always surprised to realize that their stomach contents can cause such trouble with their voice and throat. Many of these patients can be helped with subtle behavioral or lifetime changes.

Smoking: Smoking is another cause of hoarseness. Since smoking is the major cause of throat cancer, if smokers are hoarse, they should see an otolaryngologist.

Other Causes: Many unusual causes for hoarseness include allergies, thyroid problems, neurological disorders, trauma to the voice box, and occasionally, the normal menstrual cycle.

Who Can Treat My Hoarseness?

Hoarseness due to a cold or flu may be evaluated primary care physicians. When hoarseness lasts longer than two weeks or has no obvious cause it should be evaluated by an otolaryngologist (ear, nose and throat doctor). Problems with the voice are best managed by a team of professionals who know and understand how the voice functions. These professionals are otolaryngologists, speech/language pathologists, and teachers of singing, acting, or public speaking. Voice disorders have many different characteristics that may give professionals a clue to the cause.

What Patients Are Saying

Great staff. Got me in right away. Dr. Griffin is great.

I had a severely obstructive scar tissue band removed from my right nasal cavity as well as a turbinate reduction. My surgery with Dr. Rasband was 1 month ago and I am LOVING the outcome! Just a few days after surgery, I was breathing 100% better. Dr. Rasband provided me with some cool pictures of the surgery. Recovery was quite easy, I was actually able to attend a work meeting the next day in office. I saw her a few times since then for post-op appointments. No re-adherence of the scar tissue band, and I am breathing 100% better. It’s amazing to have both sides of my nose open!

Write A Review

How Is Hoarseness Evaluated?

An otolaryngologist will obtain a thorough history of the hoarseness and your general health. Your doctor will usually look at the vocal cords with either a mirror placed in the back of your throat or a very small, lighted flexible tube (fiberoptic scope) may be passed through your nose in order to view your vocal cords. Videotaping the examination or using stroboscopy (slow motion assessment) may also help with the analysis.

These procedures are not uncomfortable and are well tolerated by most patients. In some cases, special tests (known as acoustic analysis) designed to evaluate the voice, may be recommended. These measure voice irregularities, how the voice sounds, airflow, and other characteristics that are helpful in establishing a diagnosis and guiding treatment

When should I see an otolaryngologist (ENT doctor)?

  • Hoarseness lasting longer than two weeks especially if you smoke
  • Pain not from a cold or flu
  • Coughing up blood
  • Difficulty swallowing
  • Lump in the neck
  • Loss or severe change in voice lasting longer than a few days

How Are Vocal Disorders Treated?

The treatment of hoarseness depends on the cause. Most hoarseness can be treated by simply resting the voice or modifying how it is used. The otolaryngologist may make some recommendations about voice use behavior, refer the patient to other voice team members, and in some instances recommend surgery if a lesion, such as a polyp, is identified. Avoidance of smoking or exposure to secondhand smoke (passive smoking) is recommended to all patients. Drinking fluids and possibly using medications to thin the mucus are also helpful.

What Can I Do to Prevent and Treat Mild Hoarseness?

  • If you smoke, quit.
  • Avoid agents that dehydrate the body, such as alcohol and caffeine.
  • Avoid secondhand smoke.
  • Drink plenty of water.
  • Humidify your home.
  • Watch your diet–avoid spicy foods.
  • Try not to use your voice too long or too loudly.
  • Use a microphone if possible in situations where you need to project your voice.
  • Seek professional voice training.
  • Avoid speaking or singing when your voice is injured or hoarse.

Read Our Blog

Caring for Your Sore Throat


When to Worry About a Sore Throat


Frequently Asked Questions

What are voice disorders?

Voice disorders occur when the voice pitch, quality, and loudness are inappropriate for a patients age and gender.

What causes weakness in voice?

There are various causes of dysphonia. This can be due to disorders of the larynx, thryoid, or even neurologic system.

What is the difference between dysphonia and Aphonia?

Dysphonia is difficulty in speaking while aphonia is the inability to speak.

What kind of doctor treats voice problems?

A laryngologist.

Can vocal nodules be symmetrical in size?

Vicol cord nodules are bilateral and symmretric.

How are voice disorders diagnosed?

Voice disorders are evaluated by performing a history, an ENT exam, and a laryngoscopy.

How do doctors check for vocal nodules?

A flexible laryngoscopy is performed to visualize the vocal cords and look for nodules.

How do you know if your vocal cords are inflamed?

You will likely experience pain, irritation, and vocal changes.

How do you treat voice disorders?

This depends on the cause of dysphonia. This can range from reflux treatment to speech therapy to surgical procedures.

What are the symptoms of damaged vocal cords?

Symptoms include voice changes, voice strain, and throat irritation.

What causes dysphonia?

There are various causes of dysphonia. This can be due to disorders of the larynx, thryoid, or even neurologic system.

What do vocal nodules sound like?

Vocal nodules make your voice sound hoarse, breathy, or raspy.

What does dysphonia mean in medical terms?

Difficulty in speaking due to a physical disorder of the mouth, tongue, throat, or vocal cords.

What is Functional dysphonia?

This is poor voice quality without anatomic, neurologic, or other organic difficulties.

What is psychogenic Aphonia?

Aphonia is the inability to produce sound. Psychogenic aphonia is seen in patients with psychologic problems.

Can hoarseness be a sign of cancer?

Hoarsenss can be a sign of cancer, but it can also be a sign of other benign conditions.

How do you know if you have a vocal hemorrhage?

Vocal fold hemorrhage usually occurs after phonotrauma (physical stress caused by vocalizing). Symptoms include hoarseness. There is no pain or difficulty or pain with swallowing or breathing.

Is a paralyzed vocal fold treatable?

It depends on the cause of the vocal cord paralysis. Causes include injury to the nerves during surgery, neck or chest injury, stroke, tumor, virus, and neurological conditions.

What causes deep voice in females?

Longer and thicker vocal cords cause the voice to resonate at lower frequencies.

Can thyroid cause voice problems?

An enlarge thryoid can cause vocal problems.

How do I get rid of dysphonia?

This depends on the cause of dysphonia. This can range from reflux treatment to speech therapy to surgical procedures.

Is spasmodic dysphonia a symptom of MS?


What are the symptoms of an unhealthy voice?

Symptoms include voice changes, voice strain, and throat irritation.

What is behavioral voice therapy?

Behavioral voice therapy is therapy designed at improving voice and vocal parameters, such as pitch, volume, and quality.

What is Puberphonia?

This is a voice disorder characterized by a habitula use of a high-pitched voice after puberty.

What is the most common cause of voice disorders?

Common causes of voice disorders include functional dysphonia and laryngitis.


  1. www.asha.org
  2. www.medlineplus.gov
  3. www.nidcd.nih.gov


Nicolette A. Picerno, M.D.

Dr. Nicolette Picerno is double-board-certified with the American Board of Otolaryngology and the American Board of Facial and Reconstructive Surgery. She received her medical degree from Hahnemann University School of Medicine in Philadelphia, PA, and performed her residency at the Medical College of Georgia.  She completed a Facial Plastic Surgery Fellowship training in Indianapolis, Indiana. Dr. Picerno is married and has three sons.  She enjoys spending time with her family and is an avid tennis player.

Request Appointment

© Associates of Otolaryngology | Site Map | Privacy Policy | Cookie Policy | Accessibility Statement Website & Marketing by
Contact Us