Hoarseness

Definition

Hoarseness refers to a difficulty making sounds when trying to speak. Vocal sounds may be weak, breathy, scratchy, or husky, and the pitch or quality of the voice may change.

Alternative Names

Voice strain; Dysphonia; Loss of voice

Considerations

Hoarseness is most often caused by a problem with the vocal cords, which are part of your voice box (larynx) in
the throat.When the vocal cords become inflamed or infected, they swell. This can cause hoarseness.

The most common cause of hoarseness is a cold or sinus infection, which usually goes away on its own
within 2 weeks.

Another rare, but serious cause of hoarseness that does not go away in a few weeks is cancer of the voice box.

Causes

• Acid reflux (gastroesophageal reflux)
• Allergies
• Breathing in irritating substances
• Cancer of the throat or larynx
• Chronic coughing
• Colds or upper respiratory infections
• Heavy smoking or drinking, especially together
• Overuse or abuse of the voice (as in shouting or singing), which may cause swelling or growths on the vocal cords

Less common causes include:

•  Injury or irritation from a bgreathing tube or bronchoscopy
• Damage to the nerves and muscles around the voice box (from trauma or surgery
• Foreign object in the esophagus or trachea
• Swallowing a harsh chemical liquid
• Changes in the larynx during puberty
• Thyroid or lung cancer
• Underactive thyroid gland

Home Care

Hoarseness may be short-term (acute) or long-term (chronic). Rest and time may improve hoarseness. Hoarseness that continues for weeks or months should be checked by a health care provider.

Things you can do at home to help relieve the problem include:

• Talk only when you need to until hoarseness goes away.
• Drink plenty of fluids to help keep your airways moist. (Gargling does not help.)
• Use a vaporizer to add moisture to the air you breathe.
• Avoid actions that strain the vocal cords such as whispering, shouting, crying, and singing.
• Take medicines to reduce stomach acid if hoarseness is due to gastroesophageal reflux disease (GERD).
• Do NOT use decongestants which can dry out the vocal cords.
• If you smoke, cut down or stop at least until hoarseness goes away.

When to Contact a Medical Professional

Call your health care provider if:

• You have trouble breathing or swallowing
• Hoarseness occurs with drooling, especially in a small child
• Hoarseness occurs in a child less than 3 months old
• Hoarseness has lasted for more than 1 week in a child, or 2-3 weeks in an adult

What to Expect at Your Office Visit

The doctor will examine your throat, neck, and mouth and ask you some questions about your symptoms and medical history, including:

• To what extent have you lost your voice (all or partially)?
• What kind of vocal problems are you having (such as making scratchy, breathy, or husky vocal sounds)?
• When did hoarseness start?
• Does hoarseness come and go or get worse over time?
• Have you been shouting, singing, or overusing your voice, or crying a lot (if a child)?
• Have you been exposed to harsh fumes or liquids?
• Do you have allergies or a post nasal drip?
• Have you ever had throat surgery?
• Do you smoke or use alcohol?
• Do you have other symptoms such as fever, cough, sore throat, difficulty swallowing, weight loss, or fatigue?

You may have one or more of the following tests:

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

References

Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology: Head & Neck Surgery. 5th ed. St Louis, Mo; Mosby; 2010.

Feierabend RH, Malik SN. Hoarseness in adults. Am Fam Physician. 2009;80(4)363-370.

Schwartz SR, Cohen SM, Dailey SH. Clinical practice guideline: Hoarseness (Dysphonia).Otolaryngology-Head and Neck Surgery. 2009;141 (3S2)S1-S31.

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