If your voice sounds raspy or strained, you may have vocal hoarseness. Maybe you sang too loud at a concert last night, or maybe there's an underlying medical condition to blame. Read on to learn more about how to tell the difference and when to consult a specialist.

"Voice disorders are the number one communication disorder among children and adults," says Amber Koch, MS, CCC-SLP, Nebraska Medicine speech-language pathologist. "Vocal hoarseness is especially common and often goes undiagnosed because it usually resolves on its own within a couple weeks, but long-standing hoarseness needs to be addressed – ideally by an ear, nose and throat specialist – because it can sometimes be a sign of a more serious condition." 

Causes of hoarseness

Vocal hoarseness can be caused by several factors, including: 

• A cold or infection – A cold or upper respiratory infection, such as the flu or COVID-19, can make your voice hoarse, but the hoarseness should resolve on its own within about two weeks
• Bronchitis or laryngitis – Bronchitis and laryngitis are both forms of inflammation that can cause your voice to become hoarse or raspy
• Cancer – A hoarse voice that lasts more than three weeks can be a sign of a more serious issue like laryngeal cancer or esophageal cancer
• Laryngopharyngeal reflux – Often confused with GERD, laryngopharyngeal reflux occurs when stomach acid travels up the esophagus, irritating the larynx or voice box
• Muscle tension dysphonia – This clinical term for voice disorder occurs from increased activation of the throat muscles, often due to speaking or singing, and can lead to pain, vocal fatigue or changes in voice
• Neurological diseases and disorders – Certain conditions, such as Parkinson's disease or a stroke, can affect the part of the brain that controls throat muscles
• Recurrent respiratory papillomatosis – Also known as laryngeal papillomatosis, RRP, causes noncancerous tumors on the airway that can affect vocals
• Strained voice box – If you talk or sing too much, cheer too loudly, or speak in a pitch that's higher or lower than usual, you may experience hoarseness due to a strained voice box
• Vocal fold hemorrhage – Physical trauma from coughing or extensive screaming can strain the tiny blood vessels of the vocal cords, filling the vocal fold and potentially forming a small ball or vocal fold polyp
• Vocal fold nodules, cysts and polyps – Nodules, polyps, and cysts are noncancerous growths that can form on your vocal folds due to too much friction or pressure 
• Vocal fold paralysis – This occurs when one or both of your vocal folds doesn't open or close properly, typically due to an injury, lung or thyroid cancer, an infection, or a disease

When to see a health care provider

If your voice is hoarse for three or more weeks, you should see a health care provider, especially if you haven't had a cold, upper respiratory infection or the flu. 

You should also see a health care provider if you:

• Cough up blood
• Develop difficulty breathing
• Experience pain when speaking or swallowing
• Feel a lump in your neck
• Have difficulty swallowing
• Lose your voice entirely for more than a few days

Depending on your symptoms, your health care provider may refer you to a laryngologist, commonly known as an ear, nose and throat doctor or ENT. The ENT will listen to your voice and examine your head and neck, as well as check for any lumps in your neck. If there is reason for concern, the ENT may order a camera exam of the throat, called a laryngoscopy, as well as a biopsy, CT scan or MRI. 

Treatment options for hoarseness

Treatment options for hoarseness include:

• Behavioral changes
• Medication
• ENT surgery
• Multidisciplinary treatment with experts like laryngologists, speech-language pathologists, pulmonologists, gastroenterologists, allergists and physical therapists 

Preventing vocal hoarseness

There are several ways to prevent hoarseness, such as: 

• Avoiding speaking or singing too much
• Drinking plenty of water
• Abstaining from alcohol, caffeine and other fluids that dehydrate your body
• Using a humidifier, especially at night and during colder months
• Quitting smoking and staying away from second-hand smoke
• Steering clear of spicy foods
• Using pectin-based throat lozenges to keep your voice well lubricated
• Avoiding menthol-based products or anything that can dry out your voice 

Gender affirming voice services for hoarseness

How we communicate is an important part of who we are as individuals, but our communication style and the characteristics of our voice may not always fit with how we identify. The Nebraska Medicine Gender Care Clinic offers several gender-affirming services to help people develop more gender-specific communication styles, such as increasing or decreasing pitch, increasing vocal flexibility and more.

If you're experiencing voice, airway or swallowing problems, such as hoarseness, coughing, or narrowing of your airway, our specialists can help. To schedule an appointment, call 800.922.0000.