Abnormal changes in the voice are called hoarseness. Hoarseness refers to a difficulty making sounds when trying to speak, although you may very well be hoarse without having a voice problem.

Thus the concept addresses how the voice sounds. Hoarseness is most often caused by a problem with the function of the vocal cords, which are part of your voice box (larynx) in the throat. When the vocal cords become inflamed or infected, they swell. This can cause hoarseness, as can local mucosal or muscular problems.

Dysphonia is a similar concept that rather refers to the actual production of sounds but is sometimes used by clinicians as a synonym to hoarseness. Some terms which may be used to describe a voice change are: breathy, harsh, tremulous, weak, reduced to a whisper, unstable (diplophonic or with frequent register breaks).

Vocal fatigue means that the voice tires abnormally easy which may lead to vocal discomfort and hoarseness.

Risk factors for voice problems

  • Smoking (also the main risk factor for laryngeal carcinoma)
  • Excess alcohol consumption
  • Gastro-oesophageal reflux
  • Professional voice use – eg, teachers, actors and singers
  • Environment: poor acoustics, atmospheric irritants and low humidity
  • Type 2 diabetes (neuropathy, poor glycaemic control).

Who can treat hoarseness?

Hoarseness due to a cold or flu may be evaluated by family physicians, pediatricians, and internists.

When hoarseness lasts longer than two weeks or has no obvious cause it should be evaluated by an otolaryngologist – head and neck surgeon (ENT, ear, nose and throat doctor), speech/language pathologists, and teachers of singing, acting, or public speaking.

Treatment of vocal disorders

The treatment of hoarseness depends on the cause. Most hoarseness can be treated by simply resting the voice or modifying how it is used. The otolaryngologist may make some recommendations about voice use behavior, refer the patient to other speech pathologists, and in some instances recommend surgery if a lesion, such as a polyp, is identified.

Avoidance of smoking or exposure to secondhand smoke (passive smoking) is recommended to all patients. Drinking fluids and possibly using medications for reflux or to thin the mucus are also helpful.

Speech pathologists or voice therapists are trained to assist patients in behavior modification that may help eliminate some voice disorders. Patients who have developed bad habits, such as smoking or overuse of their voice by yelling and screaming, benefit most from this conservative approach.

The speech pathologist may teach patients to alter their method of speech production to improve the sound of the voice and to resolve the problems, such as vocal nodules. When a patients’ problem is specifically related to singing, a singing teacher may help improve the patients’ singing techniques.