Key Takeaways
- When your voice turns rough, breathy, weak or strained it is called hoarseness of voice, and most of the time a cold or straining your voice is behind it, though reflux can sometimes contribute.
- Mostly a hoarse voice comes back to normal in 1 to 2 weeks if you rest it and drink enough water.
- If the voice is still hoarse after 4 weeks then you need to get a throat examination done with a small camera (laryngoscopy).
- If you smoke, use bidi or drink, don’t wait that long because a hoarseness that stays can be the first sign of voice box cancer.
- For most hoarseness antibiotics and steroid tablets are of no use, so don’t take them without getting checked.
- Don’t start or stop any tablet or inhaler by yourself without asking your doctor.
- Along with the hoarse voice if you have breathing trouble, noisy breathing or blood in the cough, go to the hospital emergency straight away.
Hoarse voice is something almost all of us have had. In one big survey nearly 3 out of 10 people said they had some voice problem at some point of their life (Roy et al., 2005). It mostly happens after a cold, after some family function where you were shouting the whole night or after teaching all day, and in a few days it is gone. Trouble is when it does not go for weeks and still people keep on trying home remedies and lozenges.
In India this delay is quite common. In a hospital study from Karnataka, out of 70 patients who came with hoarseness, cancer of the voice box was the most common cause and almost all of them were men (Vivek and Shankar, 2022). Now this was a small study in a bigger hospital where more serious cases come, so it does not mean most hoarse voices are cancer, but it does show why a voice that is not getting better needs to be checked.
In this blog we will tell you what hoarseness of voice is, what are the common hoarseness of voice causes, when your hoarse voice needs a throat examination, what treatment works and how Dr. Amit Chakraborty can help you.
Voice hoarse for more than 4 weeks?
What Is Hoarseness of Voice?
Hoarseness is when your voice is not sounding the way it usually does. Somebody will say it is rough or breathy, someone else will say it feels strained or weak, sometimes the pitch keeps going up and down or you are just not able to talk loud. Doctors have a medical word for it which is dysphonia.
To understand it in easy terms, inside your voice box (larynx) there are two vocal cords and your voice comes from them. While talking the air from your lungs goes in between these cords and they vibrate really fast, kind of like guitar strings. Now if the cords become swollen, something grows on them or one cord is not moving properly, then they can’t vibrate like before and so the voice comes out hoarse.
Causes of Hoarseness of Voice
There are many hoarseness of voice causes and most of them are not serious. Below table explains the common ones:
| Cause | What it usually means for you |
| Viral laryngitis (cold, flu) | Comes with cold or cough, settles in 1 to 2 weeks |
| Shouting or using the voice too much | After a function, a match or long talking, better with voice rest |
| Vocal cord nodules | Teachers, singers and people who talk a lot, voice gets tired by evening |
| Vocal cord polyp or cyst | Mostly on one side, hoarse voice that stays |
| Acid reflux (GERD or LPR) | Throat clearing, feeling of something stuck, worse in the morning |
| Smoking (Reinke’s oedema) | Deep, rough voice in long-time smokers |
| Steroid inhaler for asthma | Hoarse voice if the mouth is not rinsed after using it |
| Low thyroid | Heavy voice along with tiredness and weight gain |
| Vocal cord palsy | Weak breathy voice, after thyroid or chest surgery or a lump pressing on the nerve |
| Nerve problems like Parkinson’s or stroke | Soft or shaky voice |
| Laryngeal cancer | Hoarseness that keeps getting worse, mostly in smokers above 50 |
Most of these are not dangerous and a few even go away on their own. But vocal cord palsy and laryngeal cancer can start just like a simple sore throat, so a hoarse voice that is not improving should never be ignored. It is also one of the common throat cancer symptoms that people miss in the start.
When Should You Get Your Hoarse Voice Checked?
The hoarseness guideline says that if your voice is not better in 4 weeks, the doctor should look at your voice box with a scope, and even earlier if they suspect something serious (Stachler et al., 2018).
| Following are the people who should get it checked early without waiting for 4 weeks: You smoke cigarettes or bidi, chew tobacco or drink alcohol regularly Your voice changed after thyroid, neck, chest or heart surgery You also have a lump in the neck, pain in one ear or pain while swallowing You are losing weight without trying You use your voice for work, like teachers, singers, call centre staff or lawyers You are coughing up blood or having trouble in breathing, and in this case go to the emergency |
These are general points so your doctor may change them as per your condition. A hoarse voice along with a lump in the neck needs to be seen even sooner, as both together can point towards laryngeal cancer.
Hoarseness That Comes and Goes vs Hoarseness That Stays
Many people get confused as their voice is okay on some days and hoarse on the other days. If it came after a cold or a day of shouting and then became normal, it was mostly strain or swelling. With nodules it is usually worse by evening and better in the morning after sleep, and with reflux the voice feels heavy in the morning. But if the voice is hoarse every day for weeks and slowly it is getting worse, that is a different thing and you should get a scope done without any delay.
Hoarseness in Teachers, Singers and Other Voice Users
If your work is about talking all day like teachers, singers, call centre staff, lawyers, priests or salespeople, your vocal cords take a lot more load than others. Many of them get nodules, which are like small corns on the cords because of rubbing again and again.
The voice becomes tired by evening, cracks while singing or talking loud, and many start clearing the throat often. Voice therapy works really well for nodules and most people don’t need surgery, but if you are a voice user don’t wait for 4 weeks, get it checked early because your income also depends on your voice.
Hoarseness After Thyroid Surgery
The nerve which moves your vocal cord runs very close to the thyroid gland. So after thyroid surgery, specially for a big goitre or thyroid cancer, some people notice their voice has become weak or breathy. This can be temporary, but a new voice change after thyroid surgery should be reported to your surgeon promptly. They may check the vocal cords with a scope, especially if you have trouble swallowing liquids or feel breathless.
What Happens During a Throat Examination?
The word scope scares many people but honestly it is a simple test and it is done in the OPD only. The doctor will first ask you since when the voice is hoarse, whether you smoke, if you have reflux, use inhalers or had any surgery lately, and then feel your neck. Then your voice box is checked in one of these ways:
- Flexible laryngoscopy, a thin tube with a camera is put from your nose after a numbing spray and the doctor may ask you to say eee to watch your cords move
- Rigid laryngoscopy, a small camera is kept at the back of your mouth while the doctor holds your tongue lightly
- Stroboscopy, in some voice clinics a special light is used that shows the cords vibrating in slow motion
It is over in a few minutes and you can go home after it. Only if the doctor sees something doubtful a biopsy is taken and scans are done. As per the guideline CT or MRI should not be done before checking the voice box with a scope (Stachler et al., 2018), as mostly the scope itself tells the reason. This simple check is the best way to detect throat cancer early.
Hoarseness of Voice Treatment
What hoarseness of voice treatment you need depends fully on the reason behind it. So first find the reason and don’t keep trying ten different tablets. Below table shows what usually helps:
| Cause | Usual treatment |
| Viral laryngitis | Voice rest, warm fluids and steam, no antibiotics needed |
| Voice overuse or nodules | Voice therapy with a speech therapist |
| Polyp or cyst | Voice therapy first, small surgery through the mouth if it stays |
| Acid reflux | Diet changes, reflux tablets if you have reflux symptoms |
| Smoking | Stop smoking, sometimes surgery for Reinke’s oedema |
| Low thyroid | Thyroid tablets |
| Vocal cord palsy | Voice therapy, injection or surgery to support the cord |
| Laryngeal cancer | Radiotherapy, laser surgery or other cancer treatment as per the stage |
One thing many people do is take an antibiotic or a steroid tablet for a hoarse voice. The guideline clearly says antibiotics should not be given for hoarseness as most of it is viral, and steroids should not be given before the voice box is checked because they have side effects and no proven benefit (Stachler et al., 2018). In the same way reflux tablets are not advised for hoarseness alone if you don’t have any reflux symptoms.
If the scope shows an area suspicious for cancer, a biopsy is needed to confirm it. The stage then helps decide what treatment you get. Early laryngeal cancer mostly needs only radiotherapy or laser surgery and a bigger surgery like laryngectomy is needed only in the advanced ones.
| Expert Insight “Many patients reach me after taking antibiotics and cough syrups for months, thinking it is just a throat infection. What I always tell them is that a voice which is hoarse for more than a month needs one simple look at the vocal cords. In most people it turns out to be something small, and when it is cancer, finding it early makes the treatment much easier.” Dr. Amit Chakraborty MBBS, MS, MCh (Surgical Oncology), MRCS (UK) Head & Neck Cancer Specialist Registered Medical Practitioner | 2008113798 |
How to Take Care of a Hoarse Voice at Home
Following are a few things that help your voice heal and also keep it healthy:
- Give rest to your voice and talk less, and don’t whisper because that puts more strain on the cords
- Keep sipping water the whole day, warm water also works
- Take steam or use a humidifier if you sit in AC for long hours
- Don’t keep clearing your throat again and again, sip water instead
- Stop smoking and keep away from smoke and dust
- Cut down on tea, coffee and alcohol as they dry the throat
- Rinse your mouth and gargle after using a steroid inhaler
- If you have reflux, don’t eat a heavy meal late at night and keep a gap of 2 to 3 hours before sleeping
These are general points so your doctor may change them as per your condition. If home care is not working in 4 weeks, it is time to get your throat examined.
When to See a Doctor for Hoarseness
| When to Get Medical Advice If it has been more than 4 weeks with a hoarse voice see a doctor, and go even earlier if you smoke or drink, had a neck or chest surgery recently or you have to talk a lot for your work. Also don’t wait if it hurts to swallow, there is pain in one ear, a lump in the neck or you are losing weight. Noisy breathing, trouble in breathing or blood in cough means going to the hospital emergency right away. |
Dr. Amit Chakraborty, Head & Neck Cancer Specialist (MBBS, MS, MCh Surgical Oncology, Registered Medical Practitioner: 2008113798), says that a hoarse voice which is not getting better is one of the easiest early signs to catch since the vocal cords can be seen in just a few minutes in the OPD. So if you are hoarse since weeks or something was seen on your cords in the scope, you can book a consultation or take a second opinion.
Worried about a voice that is not getting better?
This article is for general health education and is not a substitute for personal medical advice. Please speak to your doctor about your own symptoms.
References
- Roy, N., Merrill, R.M., Gray, S.D. and Smith, E.M. (2005). Voice disorders in the general population: prevalence, risk factors, and occupational impact. The Laryngoscope, 115(11), 1988-1995.
- Stachler, R.J., Francis, D.O., Schwartz, S.R., et al. (2018). Clinical Practice Guideline: Hoarseness (Dysphonia) (Update). Otolaryngology Head and Neck Surgery, 158(1 suppl), S1-S42.
- Vivek, S. and Shankar, G. (2022). Changing trend in the etiological spectrum of hoarseness of voice in rural India: a prospective hospital-based study. Indian Journal of Otolaryngology and Head & Neck Surgery, 74(Suppl 2), 1896-1901.
Sep 30, 2024 
