Table of ContentsView AllTable of ContentsCausesDiagnosisWhen to Call Your Healthcare Provider
Table of ContentsView All
View All
Table of Contents
Causes
Diagnosis
When to Call Your Healthcare Provider
Ahoarse voicemay be a barely noticeable change in the volume of your speech. Or it may change your voice into a raspy sound that you can hardly hear.
Jose Luis Pelaez / Iconica / Getty Images
Most of the time, causes such as a cold, allergies, or inhaled irritants are the culprit, but hoarseness should never be dismissed without talking to your healthcare provider, especially if it persists. Occasionally, hoarseness can be a sign of a serious underlying condition, like cancer or stroke.
This article explores several possible reasons you may have a raspy voice and what you can do about each one. It also highlights which symptoms may warrant a call to your healthcare provider.
Causes of Hoarseness
Hoarseness is a common symptom that most people have experienced from time to time while fighting a cold or the flu. But it can also be a symptom of something more serious.
Hoarseness can be caused in different ways. Often it is due to a problem with the vocal folds (a part of the larynx). The problem can stem directly from problems with the larynx, or instead, be due to problems with the nerves that supply the vocal folds and direct them to do what our brains are telling them to do.
Some possible causes of hoarseness include:
Vocal cord nodules:Vocal cord nodulesare “lumps” on your vocal cords that interfere with their normal closing during speaking. They usually result from overuse of your voice, much like skin calluses develop. Singers, teachers, and other professionals who use their voices a lot can get polyps. Treatment may involve rest, voice therapy, or surgery.
Allergies: Both seasonal and year-round allergies can result in hoarseness. Decongestant and antihistamine medications can be found over the counter to treat allergy-related stuffy and runny nose, sneezing, and itching. Prescription corticosteroids can be used to treat nasal inflammation.
Thyroid conditions: Thyroid conditions, especially untreated hypothyroidism (low thyroid), can cause hoarseness. The standard treatment for hypothyroidism is a medication called levothyroxine.
Smoking: Smoking and secondhand smoke exposure may result in a hoarse voice. Therapies that support smoking cessation include cognitive behavioral therapy (CBT), and medications that reduce nicotine cravings, such as nicotine replacement therapy.
Exposure to other irritating substances: Irritants, ranging from air pollution to chemicals used in the home, can cause hoarseness. Avoiding exposures is key. Staying indoors, cleaning indoor air filters routinely, and limiting outdoor exercise near pollution sources can help prevent irritation.
Long-term use of inhaled corticosteroids:Inhaled corticosteroids, a category of inhalers used chronically for asthma or COPD, can result in a hoarse voice. It appears that some inhaled corticosteroids are more likely than others to cause problems.Recovery may involve switching to a different or non-steroidal inhaler.
Cancer: Cancers of the voicebox (laryngeal cancer), throat, lungs, thyroid, and lymphomas may have hoarseness as a symptom, sometimes as the first symptom. Metastatic cancer spreading to themediastinum(the area between the lungs), can press on the recurrent laryngeal nerves leading to the voice box and cause hoarseness. Cancer treatment may involve chemotherapy, surgery, or radiation therapy.
Neurological conditions:Strokes,Parkinson’s disease, andmultiple sclerosismay all cause hoarseness due to their effects on the nerves supplying the vocal cords. Treatment focuses on managing symptoms and slowing disease progression. For example, stroke survivors and people with Parkinson’s disease or multiple sclerosis may benefit from speech therapy.
Spasmodic dysphonia:Spasmodic dysphoniais a local problem with the muscles of the larynx, resulting in hoarseness. The condition is most commonly treated with an injection of a small amount of botulinum toxin (botox) into the affected muscle tissue of the larynx.
Inhalation of a foreign body or caustic substance: Caustic chemicals and small objects can be accidentally inhaled, upper airway injury and inflammation, causing the esophagus to narrow. Treatment may involve a procedure called esophageal dilation, in which a healthcare provider dilates (stretches open) the narrow areas of the esophagus.
How Hoarseness Manifests
At rest, the vocal folds are open. When you decide to speak (or sing or scream), there are several things that have to work together in order for an audible sound to be produced. Hoarseness may result from conditions that affect any of these steps:
Step 1: The vocal folds come together.A problem with this step may occur in either the vocal folds or with the nerves which supply the vocal folds. An example may be if cancer, such as lung cancer or metastatic breast cancer, pushes on the nerve that travels to the vocal folds in the chest.
Step 2: Passing air causes the vocal folds to vibrate.When the vocal folds are closed, the air then must travel past them and cause the folds to vibrate. Again, problems may occur due to the vocal folds themselves because of anything which keeps the folds from remaining closed (nerves), or anything that prohibits the normal flow of air past the folds.
Step 3: The sound needs to exit the body.Once air moves past the vocal folds, the sound then needs to “exit” the body, Anything which interferes with the flow of air out through the throat, mouth, and nose, may interfere with the sound.
Sound passing to the outside world also resonates in the sinus cavities. This helps to explain the “nasal quality” of your voice if you have a condition affecting your sinus passageways. The sound can vary from person to person depending on how it reverberates in the sinus passages and the size of the vocal folds.
Hoarseness can either involve both vocal folds or only one.
How Is Hoarseness Diagnosed?
If you are coping with a hoarse voice, your healthcare provider will first perform a careful history, focusing on some of the questions listed below. They will then perform a physical exam, carefully evaluating your head and neck as well as chest and lungs.
Diagnostic tests will depend on your history but could include alaryngoscopy, blood tests, a computerized tomography (CT) scan of your chest, and more.
Questions Your Healthcare Provider May Ask
When you visit your healthcare provider, they will first take a careful history. Some of the questions may include:
Tests and Procedures
If your symptoms are persisting and your healthcare provider does not find an obvious cause after examining your ears, nose, and throat, they may order further tests. Some of these include:
Laryngoscopy: According to 2018 practice guidelines, people who have hoarseness that fails to go away after four weeks should have a laryngoscopy performed. This is true no matter how long the condition has been going on and even if a serious underlying cause of the hoarseness is suspected.
A laryngoscopy is a test in which healthcare providers use a flexible tube with a light attached to look down your nose at your vocal cords. Numbing medication is applied to the back of your throat before this is done, and people usually have little discomfort.
Videostroboscopy:Videostroboscopyis a procedure in which a strobe light is used to create a series of images that show slow-motion vibration of the vocal folds.
Imaging studies: Tests such as a computerized tomography (CT) scan of the chest or neck, magnetic resonance imaging (MRI), and more may be needed; it’s recommended that these be performed after a laryngoscopy is first done. If you have a history of cancer, a positron emission tomography (PET) scan may be recommended.
Other testing:A number of other tests may be done based on history and symptoms, For example, blood tests may be done if an infection is suspected, an upper GI endoscopy may be done if acid reflux is suspected, and so forth.
It’s important to see your healthcare provider if you are experiencing a hoarse voice that lasts beyond a few days. While most causes of hoarseness are benign and are due to transient causes such as a cold, it may also be a symptom of something more serious.
If your symptom persists, it’s important to make an appointment with your healthcare provider—even if you think there’s a reasonable cause. Healthcare providers vary on what they call “persistent.” In general, if your symptoms last more than two weeks, progressively worsen, or are associated with other symptoms, you should make an appointment.
If you notice the sudden loss of voice or have other concerning symptoms, such as weakness in a part of your body, visual changes, or lightheadedness, call your healthcare provider or 911 immediately.
Summary
There are many potential causes of hoarseness, ranging from laryngitis and allergies to neurological disorders and cancer. The important thing to keep in mind is that hoarseness is a symptom that something isn’t working right in your body.
Having a hoarse voice can impact the quality of your life. If you are experiencing severe hoarseness, or hoarseness that persists beyond a few days, reach out to your healthcare provider to find the cause and get treatment. Keep in mind that many possible causes are more treatable when caught early.
16 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Jaworek A, Earasi K, Lyons K, Daggumati S, Hu A, Sataloff R.Acute infectious laryngitis: A case series.Ear Nose Throat J.2018 Sep;97(9):1-8. doi:10.1177/014556131809700920DukeHealth.Treatment for vocal cord nodules, cysts, and polyps.American College of Allergy, Asthma, and Immunology.Allergy immunotherapy.Stanford Medicine.Laryngopharyngeal reflux (LPR) protocol.Chakar L, Razvi S, Bensenor I, Azizi F, Pearce E, Peeters R.Hypothyroidism.Nature Rev Dis Primer.2022 May;8(1):1-17. doi:10.1038/s41572-022-00357-7National Institute on Drug Abuse.What are treatments for tobacco dependence?.Laumbach R, Meng Q, Kipen H.What can individuals do to reduce personal health risks from air pollution?.J Thorac Dis. 2015 Jan;7(1):96-107. doi:10.3978/j.issn.2072-1439.2014.12.21Mount Sinai.Recurrent respiratory papilloma (RRP).Spantieas N, Drosou E, Bougea A, Assimakopoulos D.Inhaled corticosteroids and voice problems. What is new?.Journal of Voice. 2017. doi:10.1016/j.jvoice.2016.09.002Abumossalam A, Ahmed H, Ibrahim O, Algreisy T, Shenqiti A.Vocal cordopathy consequent to bronchial asthma inhalation therapy.Egypt J Bronchol. 2020 Jul;14(1):1-8. doi:10.1186/s43168-020-00010-5Henry County Hospital.Parkinson’s, stroke, and multiple sclerosis therapy.Children’s Hospital of Philadelphia.Laryngeal trauma.National Institute on Deafness and Other Communication Disorders.Spasmodic dysphonia?.Mount Sinai.Laryngeal nerve damage.Cincinnati Children’s.Caustic ingestion.Stachler RJ, Francis DO, Schwartz SR, et al.Clinical Practice Guideline: Hoarseness (dysphonia) (Update).Otolaryngology Head and Neck Surgery. 2018. 158(1_suppl):S1-S42. doi:10.1177/0194599817751030Additional ReadingSpantieas N, Drosou E, Bougea A, Assimakopoulos D.Inhaled Corticosteroids and Voice Problems. What is New?.Journal of Voice. 2017. doi:10.1016/j.jvoice.2016.09.002Stachler RJ, Francis DO, Schwartz SR, et al.Clinical Practice Guideline: Hoarseness (Dysphonia) (Update).Otolaryngology Head and Neck Surgery. 2018. 158(1_suppl):S1-S42. doi:10.1177/0194599817751030Stinnett S, Chmielewska M, Akst LM.Update on Management of Hoarseness.Medical Clinics of North America. 2018. 102(6):1027-1040. doi:10.1016/j.mcna.2018.06.005
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Jaworek A, Earasi K, Lyons K, Daggumati S, Hu A, Sataloff R.Acute infectious laryngitis: A case series.Ear Nose Throat J.2018 Sep;97(9):1-8. doi:10.1177/014556131809700920DukeHealth.Treatment for vocal cord nodules, cysts, and polyps.American College of Allergy, Asthma, and Immunology.Allergy immunotherapy.Stanford Medicine.Laryngopharyngeal reflux (LPR) protocol.Chakar L, Razvi S, Bensenor I, Azizi F, Pearce E, Peeters R.Hypothyroidism.Nature Rev Dis Primer.2022 May;8(1):1-17. doi:10.1038/s41572-022-00357-7National Institute on Drug Abuse.What are treatments for tobacco dependence?.Laumbach R, Meng Q, Kipen H.What can individuals do to reduce personal health risks from air pollution?.J Thorac Dis. 2015 Jan;7(1):96-107. doi:10.3978/j.issn.2072-1439.2014.12.21Mount Sinai.Recurrent respiratory papilloma (RRP).Spantieas N, Drosou E, Bougea A, Assimakopoulos D.Inhaled corticosteroids and voice problems. What is new?.Journal of Voice. 2017. doi:10.1016/j.jvoice.2016.09.002Abumossalam A, Ahmed H, Ibrahim O, Algreisy T, Shenqiti A.Vocal cordopathy consequent to bronchial asthma inhalation therapy.Egypt J Bronchol. 2020 Jul;14(1):1-8. doi:10.1186/s43168-020-00010-5Henry County Hospital.Parkinson’s, stroke, and multiple sclerosis therapy.Children’s Hospital of Philadelphia.Laryngeal trauma.National Institute on Deafness and Other Communication Disorders.Spasmodic dysphonia?.Mount Sinai.Laryngeal nerve damage.Cincinnati Children’s.Caustic ingestion.Stachler RJ, Francis DO, Schwartz SR, et al.Clinical Practice Guideline: Hoarseness (dysphonia) (Update).Otolaryngology Head and Neck Surgery. 2018. 158(1_suppl):S1-S42. doi:10.1177/0194599817751030Additional ReadingSpantieas N, Drosou E, Bougea A, Assimakopoulos D.Inhaled Corticosteroids and Voice Problems. What is New?.Journal of Voice. 2017. doi:10.1016/j.jvoice.2016.09.002Stachler RJ, Francis DO, Schwartz SR, et al.Clinical Practice Guideline: Hoarseness (Dysphonia) (Update).Otolaryngology Head and Neck Surgery. 2018. 158(1_suppl):S1-S42. doi:10.1177/0194599817751030Stinnett S, Chmielewska M, Akst LM.Update on Management of Hoarseness.Medical Clinics of North America. 2018. 102(6):1027-1040. doi:10.1016/j.mcna.2018.06.005
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Jaworek A, Earasi K, Lyons K, Daggumati S, Hu A, Sataloff R.Acute infectious laryngitis: A case series.Ear Nose Throat J.2018 Sep;97(9):1-8. doi:10.1177/014556131809700920DukeHealth.Treatment for vocal cord nodules, cysts, and polyps.American College of Allergy, Asthma, and Immunology.Allergy immunotherapy.Stanford Medicine.Laryngopharyngeal reflux (LPR) protocol.Chakar L, Razvi S, Bensenor I, Azizi F, Pearce E, Peeters R.Hypothyroidism.Nature Rev Dis Primer.2022 May;8(1):1-17. doi:10.1038/s41572-022-00357-7National Institute on Drug Abuse.What are treatments for tobacco dependence?.Laumbach R, Meng Q, Kipen H.What can individuals do to reduce personal health risks from air pollution?.J Thorac Dis. 2015 Jan;7(1):96-107. doi:10.3978/j.issn.2072-1439.2014.12.21Mount Sinai.Recurrent respiratory papilloma (RRP).Spantieas N, Drosou E, Bougea A, Assimakopoulos D.Inhaled corticosteroids and voice problems. What is new?.Journal of Voice. 2017. doi:10.1016/j.jvoice.2016.09.002Abumossalam A, Ahmed H, Ibrahim O, Algreisy T, Shenqiti A.Vocal cordopathy consequent to bronchial asthma inhalation therapy.Egypt J Bronchol. 2020 Jul;14(1):1-8. doi:10.1186/s43168-020-00010-5Henry County Hospital.Parkinson’s, stroke, and multiple sclerosis therapy.Children’s Hospital of Philadelphia.Laryngeal trauma.National Institute on Deafness and Other Communication Disorders.Spasmodic dysphonia?.Mount Sinai.Laryngeal nerve damage.Cincinnati Children’s.Caustic ingestion.Stachler RJ, Francis DO, Schwartz SR, et al.Clinical Practice Guideline: Hoarseness (dysphonia) (Update).Otolaryngology Head and Neck Surgery. 2018. 158(1_suppl):S1-S42. doi:10.1177/0194599817751030
Jaworek A, Earasi K, Lyons K, Daggumati S, Hu A, Sataloff R.Acute infectious laryngitis: A case series.Ear Nose Throat J.2018 Sep;97(9):1-8. doi:10.1177/014556131809700920
DukeHealth.Treatment for vocal cord nodules, cysts, and polyps.
American College of Allergy, Asthma, and Immunology.Allergy immunotherapy.
Stanford Medicine.Laryngopharyngeal reflux (LPR) protocol.
Chakar L, Razvi S, Bensenor I, Azizi F, Pearce E, Peeters R.Hypothyroidism.Nature Rev Dis Primer.2022 May;8(1):1-17. doi:10.1038/s41572-022-00357-7
National Institute on Drug Abuse.What are treatments for tobacco dependence?.
Laumbach R, Meng Q, Kipen H.What can individuals do to reduce personal health risks from air pollution?.J Thorac Dis. 2015 Jan;7(1):96-107. doi:10.3978/j.issn.2072-1439.2014.12.21
Mount Sinai.Recurrent respiratory papilloma (RRP).
Spantieas N, Drosou E, Bougea A, Assimakopoulos D.Inhaled corticosteroids and voice problems. What is new?.Journal of Voice. 2017. doi:10.1016/j.jvoice.2016.09.002
Abumossalam A, Ahmed H, Ibrahim O, Algreisy T, Shenqiti A.Vocal cordopathy consequent to bronchial asthma inhalation therapy.Egypt J Bronchol. 2020 Jul;14(1):1-8. doi:10.1186/s43168-020-00010-5
Henry County Hospital.Parkinson’s, stroke, and multiple sclerosis therapy.
Children’s Hospital of Philadelphia.Laryngeal trauma.
National Institute on Deafness and Other Communication Disorders.Spasmodic dysphonia?.
Mount Sinai.Laryngeal nerve damage.
Cincinnati Children’s.Caustic ingestion.
Stachler RJ, Francis DO, Schwartz SR, et al.Clinical Practice Guideline: Hoarseness (dysphonia) (Update).Otolaryngology Head and Neck Surgery. 2018. 158(1_suppl):S1-S42. doi:10.1177/0194599817751030
Spantieas N, Drosou E, Bougea A, Assimakopoulos D.Inhaled Corticosteroids and Voice Problems. What is New?.Journal of Voice. 2017. doi:10.1016/j.jvoice.2016.09.002Stachler RJ, Francis DO, Schwartz SR, et al.Clinical Practice Guideline: Hoarseness (Dysphonia) (Update).Otolaryngology Head and Neck Surgery. 2018. 158(1_suppl):S1-S42. doi:10.1177/0194599817751030Stinnett S, Chmielewska M, Akst LM.Update on Management of Hoarseness.Medical Clinics of North America. 2018. 102(6):1027-1040. doi:10.1016/j.mcna.2018.06.005
Spantieas N, Drosou E, Bougea A, Assimakopoulos D.Inhaled Corticosteroids and Voice Problems. What is New?.Journal of Voice. 2017. doi:10.1016/j.jvoice.2016.09.002
Stachler RJ, Francis DO, Schwartz SR, et al.Clinical Practice Guideline: Hoarseness (Dysphonia) (Update).Otolaryngology Head and Neck Surgery. 2018. 158(1_suppl):S1-S42. doi:10.1177/0194599817751030
Stinnett S, Chmielewska M, Akst LM.Update on Management of Hoarseness.Medical Clinics of North America. 2018. 102(6):1027-1040. doi:10.1016/j.mcna.2018.06.005
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