hoarse

Hoarseness refers to a rough, raspy, or breathy voice quality resulting from impaired vibration of the vocal folds in the larynx. It is a symptom rather than a disease, and can reflect benign inflammation to serious pathology. The term is often used interchangeably with dysphonia, though dysphonia can denote broader voice disorders.

Common causes include transient laryngitis from viral infection or vocal overuse, smoking, and irritants; gastroesophageal reflux; allergies; and structural lesions such as vocal nodules, polyps, or cysts. Less commonly, hoarseness may result from vocal cord paralysis, thyroid disease, neurological disorders, trauma, or tumors. Acute hoarseness lasting less than three weeks is usually self-limited, whereas chronic hoarseness lasting longer than three to six weeks warrants medical evaluation.

Evaluation involves a detailed history and physical examination, followed by laryngoscopy to visualize the vocal cords. Stroboscopy may be used to assess vocal fold vibration. Additional tests may include thyroid function, allergy/reflux assessment, and imaging or biopsy if a mass or cancer is suspected.

Treatment focuses on the underlying cause. For many cases, voice rest, hydration, and avoidance of irritants are first-line. Management of reflux or allergies, and smoking cessation, can help. Voice therapy with a speech-language pathologist is effective for nodules and polyps. Surgical removal may be indicated for persistent benign lesions or certain tumors. Vocal fold paralysis may require injections or operative procedures to improve voice.

Most acute hoarseness improves with conservative care. Chronic or recurrent hoarseness requires evaluation to exclude serious conditions, especially in smokers or heavy drinkers. Preventive measures include proper voice use, staying hydrated, avoiding tobacco, and managing reflux and allergies.