Hoarseness 

Introduction
Hoarseness can make it sound like you have a “frog in your throat.”  Your voice may sound rough and change throughout the day.  In most cases, hoarseness is not the sign of a serious problem and is easily treated by simply resting your voice.  However, an ear, nose, and throat specialist, ENT or otolaryngologist should evaluate persistent hoarseness. 

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Anatomy
The vocal cords (folds) are located in the voicebox (larynx) in your neck.  When you talk or sing, the vocal cords vibrate and create sound.

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Causes
Hoarseness is most frequently caused by laryngitis from a cold, upper respiratory infection, smoking, or overuse from screaming, shouting, talking loud, or talking improperly for long periods.  Any condition that affects the vocal cords can change the quality of sound that is produced.  Such conditions include swelling, bleeding, growths, dehydration, rough edges, trauma, infection, and gastrointestinal reflux disease (GERD). 

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Symptoms
Hoarseness causes the voice to sound raspy, scratchy, higher pitched, lower pitched, breathy, or strained.  The strength of your voice may fluctuate throughout the day.  Speaking may make your condition worse.

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Diagnosis
Your should contact your doctor if you have hoarseness that lasts longer than a few weeks or complete loss of your voice that last more than a few days.  You should contact your doctor immediately if you experience hoarseness and difficulty swallowing, coughing up blood, severe pain, or a lump in your neck.

Your doctor will review your medical history and lifestyle habits.  Blood tests and throat cultures may be done to help identify a medical cause.  Your doctor will examine your throat and vocal cords.  The vocal cords may be examined with an endoscope.  An endoscope is a thin tube with a viewing instrument and a light.  The endoscope is inserted through the nose to allow the doctor to view your vocal cords while you speak.  It is inserted into your mouth to create a magnified view of your vocal cord structures.

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Treatment
Treatments for hoarseness depend on the cause of the condition.  In most cases, rest (not using your voice), avoiding cigarette smoke, and drinking plenty of fluids helps.  You should not whisper, as whispering is actually harder on the vocal cords than talking.  If you frequently strain your voice or are a public speaker, you may benefit from participating in voice therapy with a speech language pathologist.
 
For people with an underlying medical cause for hoarseness, the treatment that you receive depends on the condition that you have.  For example, GERD may be treated with medications and changes in eating habits, whereas a polyp growth may need to be surgically removed, and infections may be treated with antibiotics.  Your doctor will discuss treatment and prevention recommendations that are specific to you.

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Prevention
Common ways to prevent voice problems include:

• Eating a healthy diet, exercising regularly, getting plenty of sleep.
• Drink plenty of water and avoid products that contribute to dehydration, such as caffeine, alcohol, decongestants, and antihistamines.
• Avoid spicy and acidic foods, mint, chocolate, milk products, alcohol, and carbonated beverages that can increase stomach acid and cause GERD.
• Do not smoke cigarettes and avoid second hand smoke
• Talk to your doctor before using aspirin, NSAIDS, or blood thinning medication as they can cause vocal cord bleeding and hoarseness
• Use proper breathing techniques
• Avoid forceful throat clearing or coughing.
• Use a humidifier in your home.

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Am I at Risk

Your risk for hoarseness is increased if you scream or shout, such as during sporting events, rock concerts, or cheerleading.  Public speakers are at risk for hoarseness if they do not use proper vocalization techniques.  People that smoke cigarettes have an increased risk of hoarseness because smoking dries out the mouth.

Certain medical conditions can increase your risk of hoarseness, including:

• GERD
• Upper respiratory infections
• Colds
• Bronchitis
• Dehydration
• Vocal cord polyps
• Allergies
• Smoking, the risk is greater if drinking alcohol and smoking

Less frequent risk factors include:

• Thyroid disorders
• Trauma
• Neurological conditions
• Female menstrual cycle
• Laryngeal cancer

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.