Hoarseness: Causes, Treatments, and Prevention

By Published On: September 8, 2022

There are a lot of reasons why your voice might suddenly sound breathy, raspy, or strained. But there are also things you can do to reverse it or even prevent it in the first place.

You know what your voice normally sounds like. So when you’re suddenly struggling with hoarseness, it can be a little jarring. After all, that raspy, strained voice that’s coming out doesn’t quite sound like you.

While odds are high that you’ve had hoarseness at some point in your life, it can be confusing when it comes out of nowhere, sending you down a rabbit hole of online searches. Before you panic, know this: Hoarseness is usually due to something minor and goes away in a day or two. But hoarseness that sticks around can be a sign of an underlying issue that needs to be addressed.

How can you know if your hoarseness is serious or nothing to stress about? Experts break it all down.

What Is Hoarseness?
To fully get what hoarseness is, it’s important to understand how your voice works. The sound of your voice is made by vibrations of your vocal folds, two bands of smooth muscle tissue that are opposite each other in your larynx (aka, your voice box), according to the National Institute on Deafness and Other Communication Disorders (NIDCD).

When you’re not speaking, your vocal folds stay open so you can breathe. But when you speak, the vocal folds come together while air from your lungs blows past. This makes them vibrate and create sound waves that go through your throat, nose, and mouth. All the factors that make up the sound of your voice, including the pitch, volume, and tone, are determined by the size and shape of your vocal folds and how sound resonates in your throat, nose, and mouth.

When your voice is hoarse, something in the mechanism that makes the sound of your voice goes wrong—and it’s usually a problem in your vocal folds, the NIDCD says. This leads to a breathy, raspy, or strained sound that can be softer in volume or lower in pitch.

How about the way hoarseness feels? “Sometimes it’s just a sound,” Phillip C. Song, MD, director of the Division of Laryngology at Mass Eye and Ear, tells Health. “But people will often feel a strain in their voice. They have to recruit accessory muscles to make a sound and can feel a tightening in their voice.”

What Causes Hoarseness?
There are a lot of potential reasons why you might have hoarseness, but these are the more common causes:

Laryngitis is the swelling and irritation of your voice box, and it often causes hoarseness or the loss of your voice, according to MedlinePlus. “Laryngitis is a very non-specific term that suggests there’s some sort of inflammation in the larynx,” Dr. Song says. “But it’s a very common cause of hoarseness.”

The most common form of laryngitis is an infection caused by a virus, like those that lead to a cold, the flu, or COVID-19. Laryngitis can also be caused by allergies, bacterial infection, bronchitis, injury, or irritants and chemicals. All of these can cause inflammation and irritation that can lead to hoarseness, Dr. Song says.

Other common causes of laryngitis and, in turn, hoarseness are:

Acid reflux
Gastroesophageal reflux disease (GERD) is a chronic condition that happens when the contents of your stomach come back up into your esophagus, the tube that connects your throat to your stomach, per the National Institute of Diabetes and Digestive and Kidney Diseases. Then there’s laryngopharyngeal reflux, when the stomach acid rises all the way up to the throat and larynx.

“When this happens, your throat and vocal cords are exposed to that acid, and they can become swollen and inflamed,” Omid Mehdizadeh, MD, otolaryngologist and laryngologist at Providence Saint John’s Health Center in Santa Monica, California, tells Health.

Overusing your voice
There are plenty of ways you can overuse your voice—including speaking or singing loudly and talking for too long—and that can lead to hoarseness. “If you’re overusing your vocal cords, it can cause inflammation and what’s known as phonotrauma,” Dr. Song says. “We can see short-term and long-term trauma.”

He notes that a lot of fitness instructors tend to deal with this because they’re constantly yelling to try to motivate people.

Vocal nodules, polyps, and cysts
These are non-cancerous growths that form in or along the vocal folds, the NIDCD explains. Vocal nodules form in pairs on opposite sites of the vocal folds from too much pressure or friction. Vocal polyps usually happen on one side of the vocal fold, and Dr. Mehdizadeh says they’re similar to a blood blister. A vocal cyst is a hard mass of tissue that forms inside the vocal fold.

Overall, they impact the vocal folds’ ability to work normally, leading to hoarseness. Technically, anyone can develop these, but people who use their voice professionally, like singers and actors, tend to be the most at risk, according to Dr. Mehdizadeh.

Vocal fold hemorrhage
This happens when a blood vessel on the surface of your vocal fold ruptures and the tissues fill with blood. When that happens, your vocal cords don’t vibrate the way they normally would, leading to that hoarse change in your voice. It can happen suddenly when you’re using your voice strenuously, like when you’re yelling, per the NIDCD. An isolated case can usually repair itself on its own with immediate voice rest.

Vocal fold paralysis
This is a voice disorder that happens when one or both of your vocal folds don’t open or close the right way. “When this happens, the vocal folds don’t contact each other,” Dr. Mehdizadeh says. “It can create a rough, breathy sound.” Paralysis of both vocal folds is rare, but it can lead to complications more serious than hoarseness, such as difficulty swallowing food or liquids. It is single vocal fold paralysis that is the common disorder.

There are a slew of potential causes for vocal fold paralysis, including an injury to the head, neck, or chest; lung or thyroid cancer; an infection like Lyme disease; or neurologic conditions like multiple sclerosis or Parkinson’s disease, the NIDCD says.

How to Soothe a Sore Throat Fast

When Should You See a Doctor for Hoarseness?
The NIDCD recommends that adults see their doctor if they’ve been struggling with hoarseness for more than three weeks. Dr. Song says that some doctors will recommend you don’t seek care unless it’s been three months, but he says that “if you don’t understand the reason for your hoarseness, it’s good to see someone after three weeks.” That’s especially the case if you haven’t had an obvious reason for your hoarseness, like having a cold, the flu, or COVID-19.

But if your hoarseness is also linked with symptoms like pain, trouble breathing, difficulty swallowing, or drooling, Dr. Mehdizadeh recommends seeking care ASAP. Coughing up blood and losing your voice completely for more than a few days should also be reasons to get help sooner, according to the NIDCD.

If you go to the doctor for hoarseness, they’ll likely start off by asking about your symptoms. They’ll also probably want to examine your throat, neck, and mouth. That may include an inspection of the back of your throat, including your vocal cords, with a procedure called a laryngoscopy. There are a few ways your doctor might do this, MedlinePlus explains. One is to insert a tiny mirror into your mouth and shine a light on the mirror so that the doctor can get a view of the back of your throat. Another way is to put a small flexible telescope through your nose and into your throat.

Your doctor might order other tests to diagnose your hoarseness, including a throat culture, X-rays of the neck, a CT scan, and blood tests.

How Is Hoarseness Treated?
The right treatment for your hoarseness usually depends on what’s causing that raspiness in the first place. “It can be pretty complicated because there are lots of potential different reasons why someone might have hoarseness,” Dr. Song says.

If your hoarseness is caused by a viral infection, “the best thing you can do is to rest your voice,” Dr. Mehdizadeh says. If you know it’s linked to GERD, he recommends trying to tamp down on the reflux with acid-reducing medication and dietary modifications. If you’re not sure what’s behind your hoarseness, you can try home remedies like using a humidifier in your room at night, staying well hydrated, and doing your best to avoid clearing your throat, a move he says is “never helpful” for your vocal cords.

But if your doctor determines that your hoarseness is caused by nodules, polyps, cysts, or paralysis, you may need to undergo voice rest, voice therapy, or even surgery to fix the issue, per the NIDCD.

How Can You Prevent Hoarseness?
If you have random hoarseness here and there, but it clears up pretty quickly, Dr. Song says you don’t need to stress it. But if it’s a more common issue for you and you tend to use your voice a lot in your job, the NIDCD recommends undergoing voice therapy to try to understand why this is a problem for you. In therapy, you’ll also learn exercises you can do to use your voice more efficiently in the future.

Dr. Mehdizadeh also recommends following “good vocal hygiene,” which means doing your best not to shout too much and listening to what your voice is trying to tell you. “If you feel that your voice is getting tired or strained, rest it,” he says. “Your body is trying to tell you something.”

By Published On: September 8, 2022

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