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Hoarseness

Definition

Hoarseness is having difficulty producing sound when trying to speak, or a change in the pitch or quality of the voice. The voice may sound weak, very breathy, scratchy, or husky.

Alternative Names

Voice strain; Dysphonia; Loss of voice

Considerations

Hoarseness is usually caused by a problem in the vocal cords. Most cases of hoarseness are associated with inflammation of the larynx (laryngitis).

Hoarseness that lingers for weeks or months may be caused by a variety of problems. Some causes are minor, while others are serious.

Causes

• Allergies
• Coughing (may be caused by allergies or diseases such as bronchitis)
• Excessive use of alcohol or tobacco
• Excessive use of the voice (as in shouting or singing)
• Gastroesophageal reflux
• Inhaling irritating substances
• Laryngitis
• Prolonged or excessive crying (in children)
• Viral illness

Other causes include:

• Aneurysms of the upper aorta
• Bronchoscopy or other tests (temporary)
• Cancer of the voice box (laryngeal cancer)
• Foreign object in the esophagus or trachea
• Heavy smoking and drinking, especially together
• Infectious mononucleosis
• Ingesting a harsh chemical liquid
• Overall weakness caused by other diseases
• Postnasal drip
• Puberty
• Thyroid or lung cancer
• Tonsillitis
• Vocal cord nodules or paralysis (after surgery)

Home Care

Hoarseness may be short-term (acute) or long-term (chronic), but is treated the same in most cases.

This kind of hoarseness is very resistant to medical therapy. Rest and time are the only ways to cure hoarseness that is not associated with other symptoms. Crying, shouting, and excessive talking or singing will only make the problem worse. Be patient, the healing process may take several days. Don't talk unless it is absolutely necessary and avoid whispering. Whispering can strain the vocal cords more than speaking does.

Gargling does not help the vocal cords. Avoid decongestants because they dry the vocal cords and prolong irritation. If you smoke, reduce or stop smoking.

Humidifying the air with a vaporizer or drinking fluids can offer some relief.

Treat conditions such as:

• Alcoholism
• Allergies
• Bronchitis
• Laryngitis

When to Contact a Medical Professional

Make an appointment with a health care provider if:

• You also have difficulty breathing or swallowing
• Hoarseness is accompanied by drooling, especially in a small child
• A child less than 3 months old is hoarse
• Hoarseness has lasted for more than 1 week in a child, or 2 weeks in an adult

What to Expect at Your Office Visit

If you are having severe difficulty breathing, the first priority is to restore normal breathing. This may require the placement of a breathing tube.

Once your condition is stable, the doctor will examine your throat and mouth. You will be asked questions about your symptoms and medical history, including:

• Quality
  • Did you lose your voice completely?
  • Is your voice weak?
  • Does it sound breathy, scratchy, or husky?
• Time pattern
  • Does the voice change persist?
  • Does the voice change occur repeatedly (recurrent)?
  • Has the condition worsened gradually over time?
  • At what age did the voice change begin?
  • How long have you had this symptom?
• Aggravating factors
  • Have you been shouting, singing, or otherwise overusing your voice?
  • Have you been exposed to irritating fumes?
  • Have you swallowed a harsh (caustic) liquid?
  • Have you swallowed a foreign object?
  • Do you use alcohol?
  • Do you smoke?
  • Do you have a history of allergies?
  • Has the infant or child been crying a lot?
  • Have you had recent surgery or a procedure on the mouth or throat?
• Other
  • What other symptoms do you have?
  • Do you have a fever?
  • Do you have malaise?
  • Are you coughing?
  • Are you weak?
  • Do you have a sore throat?
  • Do you feel fatigued?
  • Do you have postnasal drip?

Tests that may be done include:

• Blood tests such as a complete blood count ( CBC) or blood differential
• Laryngoscopy
• Throat culture
• Throat examination with a small mirror
• X-rays of the neck or CT scan

Treatment depends on the cause of the problem.

References

Cummings CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 4th ed. St Louis, Mo; Mosby; 2005.

Rakel P, ed. Conn’s Current Therapy 2007. 59th ed. Philadelphia, Pa: WB Saunders; 2007.

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