Hoarseness (Hoarseness): Causes of hoarse (hoarse) voice

About one in three people experience hoarseness at some point in their lives. Patients with a hoarse voice are unable to make sounds when speaking. The vocal sounds sound weak, airy, scratchy or hoarse, and the pitch or quality of the voice may also be subject to changes. Hoarseness has a number of causes, ranging from simple inflammatory processes to less common but more serious neurological conditions and cancer. Medication, smoking and other environmental factors also cause a hoarse voice. Often some symptoms are accompanied by the hoarseness of the voice. Usually, some home care remedies such as sufficient voice rest and quitting smoking help to alleviate the hoarseness. In some cases of a hoarse voice change, medical treatment is necessary.

  • What is a voice?
  • Synonyms of hoarseness
  • Causes of hoarse voice
  • Risk factors: Conditions and hoarse voice
  • Autoimmune diseases
  • Parathyroid problems
  • Infection or inflammation
  • Cancer
  • Lung problems
  • Stomach problems
  • Neurological disorders
  • Thyroid problems
  • Structural changes
  • Other causes
  • Risk factors: Environmental factors and harshness
  • Associated symptoms with hoarse voice change
  • Alarm symptoms for a hoarse voice
  • Diagnosis and examinations
  • Treatment of hoarse voice
  • Self-care
  • Professional medical care


What is a voice?

A voice is the synchronization of activities from the lung to the larynx, the movement of the tongue and lips, and the acoustic resonance through the nasal system. The larynx also plays a very important role in this process. The larynx is part of the upper respiratory tract. It produces sound when the airflow rises from the lungs to vibrate the larynx. When speaking, the larynx closes and opens differently with each syllable to produce variable sounds of varying intensity. If the vibration of the larynx is unstable, or the larynx is swollen and cannot close, a hoarse sound is produced.

Synonyms of hoarseness

Synonyms for hoarseness are:

  • dysphonia
  • a hoarse voice
  • a hoarse voice
  • a hoarse voice
  • a hoarse voice
  • hoarseness of the voice
  • hoarseness of the voice


Causes of hoarse voice

Hoarseness is usually the result of a problem with the vocal cords. The vocal cords are part of the voice box (larynx) in the throat. When the vocal cords become inflamed or infected, they swell. This causes a hoarse voice.

Risk factors: Conditions and hoarse voice

Some conditions may be the cause of a hoarse voice:

Autoimmune diseases

The following autoimmune conditions may cause hoarseness of the voice:

  • rheumatoid arthritis (inflammation of joints and organs)
  • systemic lupus erythematosus


Parathyroid problems

A hoarse voice is sometimes due to a parathyroid condition:

  • a parathyroid adenoma (benign tumor of the parathyroid gland)
  • hypoparathyroidism (underactive parathyroid gland(s))


Infection or inflammation

Very often voice changes such as a hoarse voice are due to inflammation or infection:

  • anthrax (anthrax: bacterial infection with symptoms on the skin and lungs)
  • bronchitis (inflammation of the trachea)
  • the flu
  • diphtheria (bacterial infection of the throat and respiratory tract)
  • a sinus infection
  • a throat infection: fatigue, headache, coughing, sore throat, congestion (clogged sinuses)
  • an inflammation of the larynx (laryngitis): sore throat, fever, runny nose, dry cough, hoarse voice
  • a cold: fatigue, headache, cough, sore throat, congestion
  • epiglottitis (life-threatening inflammation of the epiglottis)
  • Pasteurella multocida (bacterial infection pasteurellosis)
  • pseudocroup (barking cough with shortness of breath)
  • tonsillitis (tonsillitis)
  • tracheitis (inflammation of the windpipe)
  • tuberculosis (bacterial infection with lung problems)
  • uvulitis (inflammation and swelling of the uvula of the tongue)



Some types of cancer cause dysphonia:

  • a lymphoma
  • throat cancer
  • lung cancer: fatigue, coughing, chest pain, shortness of breath
  • mediastinal metastases (cancer spread in the space in the chest between the two lungs)
  • oral cancer
  • thyroid cancer
  • esophageal cancer
  • vocal cord cancer
  • laryngeal cancer (symptoms of sore throat and earache)


Lung problems

Lung disorders may result in a hoarse voice:

  • aspiration pneumonia (pneumonia due to inhaling foreign substances)
  • Cladosporium fungi
  • COPD (chronic obstructive pulmonary disease)

A mediastinoscopy, an internal examination of the space in the chest between the lungs, may also lead to the voice change.

Stomach problems

The hoarse voice is sometimes due to a stomach condition:

  • a stomach hernia (hiatus hernia)
  • bile reflux (backflow of bile into the stomach and esophagus): nausea, sore throat, coughing with dry or watery sputum, pain under the ribs, deep pain in the chest, behind the breastbone
  • gastroesophageal reflux (symptoms of heartburn


Neurological disorders

A hoarse voice is sometimes due to a neurological disorder:

  • Parkinson’s disease (neurological disorder with tremors)
  • an acoustic neuroma (benign tumor in the cranial nerve)
  • a stroke (insufficient blood supply to the brain with mental and physical symptoms)
  • the Smith-Magenis syndrome
  • the Weaver syndrome
  • multiple sclerosis
  • damage to the vocal cord nerve
  • spasmodic dysphonia


Thyroid problems

Dysphonia is sometimes the result of a problem with the thyroid gland:

  • hypothyroidism: fatigue, depression, concentration problems, weight gain, muscle pain
  • myxedema (complication of underactive thyroid gland)
  • thyroid nodules
  • Hashimoto’s disease (decreased thyroid function): fatigue, difficulty concentrating, weight gain, constipation, diarrhea


Structural changes

Structural abnormalities also cause a change in voice, resulting in hoarseness:

  • bleeding in the vocal cords
  • a cyst (abnormally shaped sac-like cavity in the body)
  • throat polyps
  • vocal cord nodules
  • vocal cord polyps


Other causes

The following conditions may also lead to hoarseness of the voice:

  • acromegaly (overproduction of growth hormone in pituitary tumor)
  • congestive heart failure: Changes in the blood vessels surrounding the heart stimulate the nerve that controls the movement of the vocal cords, resulting in a weak, hoarse voice.
  • an allergic reaction and anaphylaxis (severe allergic reaction)
  • an aneurysm in the chest cavity (bulge of part of an artery)
  • trauma to the larynx, throat or vocal cords
  • a foreign object in the trachea
  • Sjögren’s syndrome (condition with dry eyes, dry mouth and dry throat)
  • linear IgA dermatosis (disorder of skin and mucous membranes)
  • psychological problems (tension on the larynx muscles) such as stress
  • sarcoidosis (causing granulomas on the vocal cords)
  • sleep apnea: fatigue, irritability, daytime sleepiness, sleep problems, sore throat
  • Dehydration: Water is an important component for the voice. The larynx vibrates hundreds of times per second when talking and singing. Water helps thin the mucus when the larynx vibrates. A dry throat therefore leads more quickly to a hoarse voice.

 Exposure to smoke may cause a hoarse voice / Source: Geralt, Pixabay

Risk factors: Environmental factors and harshness

Hoarseness of the voice is sometimes the result of environmental factors:

  • alcohol abuse
  • Occupation: Hoarseness is more common in people who have to use their voice often or loudly, such as construction workers, singers, teachers and telephone operators, …
  • side effect of medications (hormones, antihistamines, anticholinergics)
  • gender: women are more likely than men to be affected by a hoarse voice
  • inhaling (inhalation) medications for the treatment of asthma (chronic inflammation of the airways in the lungs) or bronchitis (inhaled corticosteroids)
  • inhaling tobacco smoke (smoking), chemicals, air pollution, or other respiratory irritants
  • the misuse of the voice
  • intubation causing damage to the vocal cords
  • old age
  • excessive use of voice, shouting, shouting, talking, singing too loudly: sore throat, hoarse voice


Associated symptoms with hoarse voice change

A voice change occurs with hoarseness. The voice sounds different for everyone: deep, tense, hard, raspy, out of tune, trembling or weak. One or both vocal cords are affected. The altered voice sound (loss of voice) is usually temporary in nature and then disappears spontaneously. However, in some cases, the hoarseness of the voice is a permanent symptom. Furthermore, the hoarseness appears gradually or suddenly. The following symptoms may be associated with the voice change:

  • general: vomiting, runny nose, loss of appetite, fever, nausea, body fatigue (asthenia)
  • coughing: chronic coughing and smoker’s cough
  • throat: a lump in the throat, a dry throat, a feeling of sputum in the throat, a blocked throat, swollen vocal cords, sore throat, shortness of breath
  • mouth: dry mouth, mouth breathing, a sour taste in the mouth, swollen taste buds, difficulty speaking, altered speech quality or pitch or a different voice volume
  • ears: ringing in the ears (tinnitus aurium)
  • psychological: stress, anxiety, social isolation, despondency, depression
  • swallowing: pain in swallowing (odynophagia), difficulty swallowing (dysphagia), frequent swallowing of saliva


Alarm symptoms for a hoarse voice

In a number of cases a visit to a doctor is necessary:

  • persistent fever
  • breathing problems
  • coughing up blood
  • swallowing problems
  • voice change that lasts for more than two weeks
  • increasing pain

 If there are signs of an infection, a blood test is necessary / Source: Frolicsomepl, Pixabay

Diagnosis and examinations

The doctor first starts with a specific medical history of the patient, and then conducts a physical examination. In patients who experience symptoms that last longer than two weeks, who smoke, use alcohol heavily and/or who vomit blood, laryngoscopy is recommended. This is an internal examination of the throat, larynx and vocal cords. This investigation is also required when a wait-and-see policy with voice rest has not been effective. Furthermore, a stroboscopy (internal visual examination of the vibration of the vocal cords) and a video recording of the voice use are useful examinations. A CT scan gives the doctor an idea of the structures of the neck and chest. A PET scan is recommended if the patient has had cancer in the past. If the doctor suspects that the patient is suffering from a form of cancer, a biopsy is required. Finally, a blood test will reveal any signs of an infection.

Treatment of hoarse voice


Healthy lifestyle It is also essential to get enough sleep. Without enough sleep, the vocal cords do not have time to recover from the irritation that occurred during the day. Stopping drinking large amounts of alcohol and caffeine is another good piece of advice. Furthermore, it is essential to quit smoking and also avoid exposure to smoke. Spicy foods are not recommended for patients with gastroesophageal reflux; This worsens the symptoms of heartburn and also causes irritation to the larynx and vocal cords.Good hand hygiene is necessary / Source: Gentle07, PixabayPreventing infection Finally, reducing the risk of infection is possible by washing hands often and thoroughly (good hand hygiene ) and avoiding contact with patients with an upper respiratory infection.Avoiding Irritants If the patient develops voice hoarseness due to an allergic reaction, it is important to avoid or eliminate the allergen (irritant) if possible.Care for the voice Treatment should start with voice rest. This means that the patient is not allowed to talk, scream, shout or whisper. Drinking enough fluids (water) is important to moisten the throat sufficiently. Breathing steamed air (warm water with chamomile or thyme in it) adds moisture to the lining of the vocal cords, making them less dry and making the voice sound clearer. The use of a humidifier is also recommended.

Professional medical care

The doctor treats the underlying cause.Medication Proton pump inhibitors (medications that reduce stomach acid) are suitable for hoarseness due to reflux. Antihistamines can be used to treat allergic reactions (such as hay fever). Corticosteroids reduce inflammation. Bacterial infections can be successfully treated with antibiotics. Botox injections treat spasmodic dysphonia (neurological voice disorder). Depending on the cause, other medications can also be used.Surgery The doctor removes nodules, polyps and cysts via surgery (microsurgery), but voice therapy is also necessary afterwards. The doctor treats cancer with a combination of surgery, radiotherapy and/ or chemotherapy.Speech therapy Speech therapy (speech therapy) is effective for improving voice quality in patients with dysphonia when conservative measures are unsuccessful. In addition, speech therapy is useful for patients who are at high risk for voice changes, such as vocalists and public speakers.

read more

  • Spasmodic dysphonia: Neurological voice disorder
  • Vocal cord disorders: Disorders of vocal cords
  • Loss of voice (aphonia): Causes of loss of voice