Hoarseness and Laryngitis: Why a Voice Changes, What Helps and When to Be Seen

What it involves

MedlinePlus defines hoarseness as difficulty making sounds when trying to speak, where the voice may be weak, breathy, scratchy or husky, or the pitch may change. It is most often caused by a problem with the vocal cords, and laryngitis is swelling and irritation of the voice box.

Who this is for

• Adults whose voice has been rough or weak for more than a week or two
• Patients who lose their voice repeatedly, especially after speaking, singing or shouting at work
• Smokers and drinkers who notice a lasting change in their voice
• Patients with heartburn, chronic cough or postnasal drip who also have a husky voice

What to expect

• Questions about when it started, whether it comes and goes, and how much you use your voice
• An exam of the throat, neck and mouth, and a look at your overall health
• Advice on voice rest, fluids and moisture, and treatment of any reflux or allergy driving it
• Referral to an ear, nose and throat specialist for a scope exam if the hoarseness is lasting

How the voice box makes the problem

The vocal cords sit in the voice box, or larynx, in the throat. MedlinePlus says that when they become inflamed or infected, they swell, and the swelling is what causes hoarseness. In laryngitis the swelling and irritation involve the voice box itself, most often because of a virus. In some cases, MedlinePlus adds, the airway can be partly blocked, which is why a hoarse voice with trouble breathing is treated very differently from a hoarse voice alone.

The usual suspects

MedlinePlus calls a cold or throat infection the most common cause, one that usually goes away within about two weeks. Other causes it lists include acid reflux, allergies, breathing in irritants, chronic coughing, and heavy smoking or drinking, especially together. Overusing the voice by shouting or singing can eventually cause vocal cord nodules, which are growths on the cords. Less common causes include nerve damage after surgery or injury, an underactive thyroid, a foreign object in the airway, and cancers of the throat, larynx, thyroid or lung.

What you can try at home

MedlinePlus suggests talking only when you need to until the hoarseness settles, drinking plenty of fluids to keep the airways moist, and using a vaporizer to add moisture to the air. It says gargling does not help, and that whispering, shouting, crying and singing strain the cords. It advises against decongestants, which can dry out the vocal cords, and suggests cutting down on smoking or stopping at least until the voice recovers. If reflux is behind the problem, medicine to reduce stomach acid may be recommended; the acid reflux guide explains how reflux can reach the throat.

The two-to-three-week line

The time limit matters. MedlinePlus says hoarseness lasting more than four weeks should be checked by a provider, and that hoarseness that has lasted two to three weeks in an adult is a reason to make contact sooner. It explains that a rare but serious cause of hoarseness that does not clear in a few weeks is cancer of the voice box, which is why a long-lasting change in someone who smokes should not simply be waited out. Most hoarseness is harmless, and the line exists so the uncommon exception is not missed.

What a visit may include

MedlinePlus says a provider will examine the throat, neck and mouth and ask about your symptoms and history: how much of the voice is lost, when it began, whether it fluctuates, whether you have been shouting or exposed to fumes, and whether you smoke or drink. Tests it names include looking at the vocal cords with a scope (a laryngoscopy), a throat culture, neck x-rays or CT, and blood tests. A primary care provider starts with the exam and history, and the scope or imaging is arranged through referral. The sore throat guide covers the infection side.

When it should not wait

MedlinePlus says to contact a provider if you have trouble breathing or swallowing, or if hoarseness comes with drooling in a small child. It also says hoarseness in a child younger than three months needs attention, as does hoarseness lasting more than a week in a child. Several forms of laryngitis in children, such as croup and epiglottitis, can lead to a dangerous blockage of the airway, so children are held to a shorter time limit than adults. This page is written for adults.

Sources

• MedlinePlus — Hoarseness
• MedlinePlus — Laryngitis