Hoarse voice

What is a hoarse voice?

A hoarse voice, medically called dysphonia, is when your voice sounds different from usual, perhaps raspy, strained, weak, or breathy – sometimes with a different pitch or loudness than you'd expect. It happens when your vocal cords, inside your voice box, become irritated, inflamed or don't vibrate together as they should.

What usually causes a hoarse voice?

Everyday causes are by far the most common, such as:

• overusing or straining your voice, such as shouting, singing for long periods, or talking loudly over background noise
• a cold, flu, or throat infection, which inflames the vocal cords
• allergies or irritants in the air, such as smoke, dust, or strong chemical fumes
• acid reflux reaching your throat, sometimes causing a sour taste or a frequent need to clear your throat alongside the hoarseness
• Smoking.

Less commonly, a hoarse voice can come from small growths on the vocal cords caused by chronic strain, an underactive or overactive thyroid, a thyroid nodule pressing on your voice box, or, rarely, an affected nerve supply to your vocal cords, which can stem from conditions elsewhere in your chest or neck.

Are there different types of hoarse voice?

It helps to think about hoarseness in terms of how long it lasts and what's likely behind it:

• Short-lived hoarseness: This the most common kind, usually follows an infection, a bout of overuse, or exposure to an irritant, and tends to clear up within days to a couple of weeks
• Longer-lasting hoarseness: This can develop when repeated vocal strain leads to small growths, such as nodules, polyps, or cysts, forming on the vocal cords
• Hoarseness linked to reflux: This tends to come with a sour taste, throat clearing, or a burning feeling, and can cause ongoing irritation if the reflux itself isn't addressed
• Hoarseness with a cause outside the voice box itself: For example a thyroid problem or, rarely, an affected nerve supply, often comes with other symptoms and needs a fuller assessment.

How is a hoarse voice diagnosed?

A clinician will usually start by asking about your symptoms, such as how long you've been hoarse, whether you smoke, and if you have any related symptoms like heartburn or a cough.

The key examination is looking directly at your vocal cords, most often using a thin, flexible camera passed gently through your nose – this is a routine outpatient procedure requiring very little preparation beforehand.

Depending on what's found, further tests might include a more detailed camera examination under general anaesthetic, which can also take a tissue sample if needed, a CT scan if a nerve problem is suspected, thyroid blood tests, or an ultrasound if a thyroid cause seems likely.

How is a hoarse voice treated?

For everyday hoarseness, simple self-care is usually enough:

• Rest your voice, and try to avoid whispering too, since it can strain your vocal cords just as much as normal talking
• Drink plenty of fluids, and cut back on caffeine and alcohol, which can dry your throat out
• Breathe in steam, or use a humidifier, to keep your throat moist
• Steer clear of smoke and other irritants, and get support to stop smoking if that's a factor.

If a specific cause is found, treatment is aimed at treating that:

• antihistamines or avoiding triggers for allergies
• medication to reduce acid for reflux
• voice therapy with a speech and language therapist for vocal strain or small growths on the vocal cords
• surgery for thyroid nodules.

Growths on the vocal cords are sometimes removed surgically, partly to treat the hoarseness and partly to check the tissue isn't cancerous.

When should you see a doctor?

Get your hoarse voice checked if it hasn't improved after about two to three weeks, particularly if it isn't linked to an obvious cold or throat infection.

It's also worth being seen sooner if you use your voice heavily for work, such as teaching, singing or public speaking.

See a doctor promptly if your hoarseness comes with a lump in your neck, difficulty or pain when swallowing, coughing up blood, unexplained weight loss, or if you lose your voice completely for more than a few days.