In most cases, the hoarse, raspy, croaky voice comes on quickly; with voice rest and plenty of fluids, it goes away equally quickly, usually in three to five days. If changes in the voice occur without an identifiable cause, however, or if they last two weeks or longer, it’s important to see a doctor. The hoarseness may be a symptom of a serious medical condition that requires early identification and treatment.
The larynx or voice box is a structure built of cartilage, muscle and mucus membrane located at the top end of the windpipe. Sound is created when air passes over the vocal cords inside, causing them to vibrate at varying wave lengths. The final speech product is then produced by the throat, the tongue and the lips.
When the vocal cords become inflamed and swollen, they are unable to vibrate as they normally would, and the result is hoarseness, a distortion of the voice or even temporary loss of voice. Other symptoms of laryngitis include a raw or tickling feeling in the throat, a dry cough and a constant need to clear the throat.
Treat the Underlying Cause
When it’s caused by a respiratory infection, hoarseness is relieved by treating the underlying cause. For a viral infection, that means drinking plenty of fluids, using a humidifier to moisten the air in the environment, sucking cough lozenges and taking over-the-counter medications to reduce coughing. For bacterial infections, antibiotics may also be needed.
Vocal cord stress is also a common cause. Under stress or trying to be heard above background noise, some individuals raise their vocal pitch. When their voice starts to become gravelly, they raise the pitch even higher, setting the stage for chronic irritation. When an individual already bothered by a cold or allergy has to carry on with teaching or conducting a meeting, serious strain can occur.
Laryngitis can also result from smoking, allergies, chronic bronchitis or inhaling chemicals or other irritants. Heartburn, or gastroesophageal reflux disease (GERD) can cause regurgitation of acids that inflame the vocal cords. In many cases, the stomach acids irritate the throat during the night, and the person experiences hoarseness the next morning.
Whatever the cause, it’s important to rest a croaky voice–speaking as little as possible. Many people resort to whispering, but that’s no solution, since it creates an air flow pattern that’s just as hard on the vocal cords as loud speaking. There’s also a natural tendency to clear the throat, but this too can make swelling even worse and should be avoided.
Sucking throat lozenges and drinking plenty of fluids can speed recovery.
When the Frog Doesn’t Go Away
Chronic hoarseness can have some of the same causes and same remedies listed above. Nevertheless, it’s important to see a doctor for any voice change lasting two weeks or longer. Chronic hoarseness is fairly common with aging. The vocal cords can lose some of their elasticity or nerves serving them can be damaged by a stroke or an injury. Ironically, a man’s voice tends to become higher, a woman’s, lower with aging. Sometimes contact ulcers or sores develop on the cartilage of the vocal cords in response to chronic irritation. If these are caused by the regurgitation of stomach acids, the first step is treatment of the stomach disorder. Voice retraining may also be necessary to reduce the irritation.
A polyp is a small swelling that occurs under the mucus membranes covering the vocal cords, often associated with smoking or voice over-use. Surgical removal of polyps is usually performed under general anesthesia. To prevent recurrence, smoking cessation and voice retraining are usually recommended.
Nodules are callus-like growths that develop in the mucus membranes. They often respond to several weeks’ rest; otherwise, they can be removed surgically, followed by voice therapy.
Any hoarseness that persists or gets progressively worse over two or three weeks raises concern about a possible cancer sign–particularly if the hoarseness is accompanied by difficulty swallowing, coughing up blood, or a lump on the neck or in the throat. In many cases of throat cancer, hoarseness may be the first or only symptom noticed.
While not a disease itself, hoarseness should be taken as a sign that something has gone wrong with the mechanism that produces speech. Usually, the remedy involves simple common sense measures such as resting the voice and learning how to use it without straining the vocal cords. When in doubt about the cause of lingering hoarseness, don’t waste time. Seek a consultation with a medical specialist.
Tana N Kaefer, PharmD
