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.

Voice strain; Dysphonia; Loss of voice

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

Hoarseness that continues for weeks or months should be checked by a health care provider. Although some causes are minor, more serious causes, such as laryngeal cancer, are possible.

• Acid reflux (gastroesophageal reflux)
• Allergies
• Breathing in irritating substances
• Cancer of the throat or larynx
• Chroniccoughing
• Colds or upper respiratory infections
• Heavy smoking or drinking, especially together
• Overuse or abuse of the voice (as in shouting or singing)

Other causes include:

• Aneurysms of the upper aorta
• Breathing tube orbronchoscopy
• Damage to the nerves attached to the voice
• Foreign object in the esophagus or trachea
• Ingesting a harsh chemical liquid
• Puberty
• Thyroid or lung cancer
• Underactive thyroid gland
• Vocal cord nodules
• Weakness of muscles around the voice box caused by nerve or muscle disorders

Hoarseness may be short-term (acute) or long-term (chronic).

Rest and time may improve the hoarseness. Crying, shouting, and too much talking or singing may make the problem worse. Be patient, because the healing process may take several days. Don't talk unless you really need to 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

Make an appointment with a health care provider if:

• You also have difficulty breathing or swallowing
• Hoarseness occurs with 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

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 continue?
  • Does the voice change occur repeatedly (recurrent)?
  • Has the condition gotten worse 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 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:

• 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 may be done.

Treatment depends on the cause of the problem.

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.