The Medical Minute: Getting to the root cause of hoarseness

Springtime brings with it blooming flowers, tall grass and, for some, a raspy voice. Yet seasonal allergies are far from the only cause of hoarseness, and it’s a condition that’s more common than people might think.

“About one-third of us will develop some sort of voice problem in our lifetime,” said Speech Language Pathologist Carrie Ruggiero, who sees patients at Penn State Health Lime Spring Outpatient Center in Lancaster.

Many think hoarseness is only a problem for famous singers, voice actors or stage performers. And they are among those at highest risk. But so too is anyone who uses their voice often during the day. That can include teachers, call-center staff, sports coaches, attorneys and salespeople, among others.

Clinically, hoarseness goes by the name dysphonia. It involves what most of us call our vocal cords, which in reality, are our vocal folds. ”Hoarseness can be a sign that there is some level of swelling in your vocal folds,” Ruggiero said. Voice changes can also be caused by certain neurologic changes, vocal fold paralysis or more serious vocal fold lesions.

The causes of that swelling can vary greatly. The most common cause is a cold or upper respiratory infection. Acid reflux and smoking can cause hoarseness, too. Some people develop a hoarse voice as they age. Hoarseness can be a side effect of some medications. It is also common in some neurologic diseases such as Parkinson’s disease.

The good news is that hoarseness is benign in most cases and will go away on its own. However, if your hoarseness doesn’t start to resolve within three to four weeks, you should see your primary care physician—especially if you’re not having any other symptoms of illness. “It’s not normal to have persistent hoarseness outside of a cold, respiratory infection or the presence of allergens,” Ruggiero said.

Sometimes, a hoarse voice can mask a more serious health condition, including some types of head and neck cancer. Red flags to look for in addition to hoarseness include coughing up blood, throat pain, difficulty swallowing, trouble breathing, any lumps or bumps in your neck, or sudden changes in your voice that last for a couple of days.

An ear, nose and throat doctor can diagnosis and treat hoarseness. They will use a device called a laryngoscope to view your larynx or voice box. If the doctor sees something they need to look at further, the patient may need to return for a biopsy.

People who use their voice often, along with chronic throat clearing, may run the risk of developing benign vocal lesions. There are different types of noncancerous growths such as polyps or nodules. These lesions can often go away with the right treatment and voice therapy.

The most common treatment for hoarseness is to rest the voice. Many people also benefit from vocal therapy, conducted by speech language pathologists. “Voice therapy can help eliminate muscle tension, help with vocal modification and address the causes of hoarseness,” Ruggiero said. It often includes a combination of breathing exercises, laryngeal massage and vocal modification techniques.

Ruggiero also teaches people the benefit of good vocal hygiene. Some best steps to soothe an aching voice include:

• Proper hydration – Drink water with each meal.
• Cut back on caffeine and alcohol – Both can dry out your throat, thicken mucous and therefore create hoarseness.
• Limit talking over loud background noise – This includes talking in loud places and even talking on the phone while seated in a car. People whose jobs require talking over background noise (aerobics instructors, coaches) should use a microphone or other amplifying device to help protect their voice.

“People don’t realize that there’s a lot we can do to help them through an acute case of hoarseness,” Ruggiero said. “You don’t have to live with it.”

Related content:

• Medical Minute: Trying to quit smoking? Don’t go it alone
• The Medical Minute: Head and Neck Cancer — What you need to know

The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians and staff, and are designed to offer timely, relevant health information of interest to a broad audience.

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