Hoarse Voice

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What is hoarse voice?

Hoarse voice is an abnormal change in your voice caused by disorders in the vocal cords of the voice box, or larynx. The vocal cords are normally open but make sounds by coming together when you speak, sing or hum. As air leaves the lungs, it makes the closed folds vibrate, producing the sound of your voice. When your voice is hoarse, it is an indication that these vibrations of the vocal folds are being hindered by mucus, swellings, obstructions or other changes in the surface of the larynx.

While any change in the quality of your voice can be referred to as hoarse voice, the features of your voice most frequently affected are either voice quality (producing a raspy, strained or gravelly sound), volume (weak or soft, breathy, croaking, fading or loud), pitch of your voice (higher or lower, depending on the cause), or some combination of these features.

Hoarse voice can be caused by colds, flu, allergies, talking or shouting for long periods of time, tobacco or marijuana use, other causes of inflammation, and, in some cases, growths in the throat (cysts, nodules, polyps or even tumors). In addition, reflux disorders (flow of stomach acids and digestive enzymes up into the throat) can cause burns that may make you hoarse. Less common causes include neurologic disorders, thyroid or hormonal disorders, and laryngeal cancer.

Hoarse voice is not usually an emergency condition. However, in fairly rare cases, hoarse voice may be a symptom of a life-threatening condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have a hoarse voice accompanied by serious symptoms such as chest pain, choking, or severe difficulty breathing.

Seek prompt medical care if your hoarse voice lasts longer than three weeks (especially if you smoke), if you observe severe changes in your voice for more than three days, if speaking or swallowing become painful but you show no signs of flu or cold, if any change in your voice accompanies difficulty breathing, if you begin coughing up blood, or if you smoke and become hoarse (smoking is the leading cause of throat cancer).

What other symptoms might occur with hoarse voice?

Hoarse voice may accompany other symptoms, which will vary depending on the underlying disease, disorder or condition. Symptoms that frequently affect the respiratory system may also involve other body systems.

Respiratory symptoms that may occur along with hoarse voice

Hoarse voice may accompany other symptoms affecting the respiratory system including:

Other symptoms that may occur along with hoarse voice

Hoarse voice may accompany symptoms related to other body systems. Such symptoms may include:

Symptoms that might indicate a serious condition

In some cases, hoarse voice may occur with other symptoms that might indicate a serious condition that should be immediately evaluated in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have hoarse voice along with other serious symptoms including:

  • Chest pain
  • Coughing up blood (hemoptysis)
  • Difficulty breathing
  • Persistent lump in the throat
  • Pus or white patches covering the tonsils or throat
  • Tremors
  • Unexplained weight loss
What causes hoarse voice?

Misuse of the voice, such as prolonged talking or shouting, is a common cause of hoarse voice. Other possible causes include tobacco use, marijuana use, and exposure to chemicals—even those found in some household cleansers—or pollutants.

Hoarse voice can also be a result of allergies, inflammation, colds, flu, or reflux disorders (regurgitation of stomach acids and digestive enzymes up into the throat) and, in some cases, neurologic disorders, thyroid or hormonal disorders, or laryngeal cancer.

Common causes of hoarse voice

Hoarse voice may be caused by several types of common throat injuries including injury from:

  • Excessive voice use
  • Marijuana use
  • Speaking loudly for extended periods
  • Using unnatural inappropriate pitch when speaking
  • Tobacco use
  • Vocal hemorrhage following strenuous vocal use

Respiratory causes of hoarse voice

Hoarse voice may be caused by several respiratory-related disorders including:

  • Allergies
  • Common cold (viral respiratory infection)
  • Inflammatory disorders such as laryngitis
  • Influenza (flu)
  • Tumor of the larynx
  • Vocal cord lesions

Gastrointestinal causes of hoarse voice

Hoarse voice can also be caused by several reflux disorders (regurgitation of stomach acids and digestive enzymes up into the throat) including:

Other causes of hoarse voice

Other body system functions and disorders can also contribute to hoarse voice. These instances include:

  • Goiter

  • Paralysis of the vocal cords

  • Spasmodic dysphonia (involuntary movements of vocal cord muscles)

  • Thyroid nodules or tumors

Serious or life-threatening causes of hoarse voice

In some cases, hoarse voice may be a symptom of a serious or life-threatening condition that should be immediately evaluated in an emergency setting. These include:

  • Epiglottitis (life-threatening inflammation and swelling of the epiglottis, a tissue flap between the tongue and windpipe)

  • Laryngeal cancer

  • Serious hemorrhage

Questions for diagnosing the cause of hoarse voice

To diagnose your condition, your doctor or licensed health care practitioner will ask you several questions related to your hoarse voice including:

  • How long have you had a hoarse voice?

  • Do you recall straining your voice recently?

  • Does your throat feel painful or dry?

  • Have you had a cough?

  • Are you having any difficulty breathing? Difficulty swallowing?

  • Have the glands in your neck felt swollen or tender to the touch?

  • Do you use tobacco or marijuana?

  • Have you been vomiting recently?

  • Do you ever experience food from your stomach regurgitating up into your throat?

  • Do you have any other symptoms?

  • What medications are you taking?

  • Have you been exposed to any chemicals or fumes?

What are the potential complications of hoarse voice?

Left untreated, a chronically misused or overused larynx, the most common cause of hoarse voice, can lead to thickening and calluses on the surfaces of the vocal folds. Because hoarse voice can be due to serious diseases, failure to seek treatment can result in serious complications and permanent damage. Once the underlying cause is diagnosed, many of these complications can be avoided. For that reason, it is important for you to follow the treatment plan that you and your health care professional design specifically for you to reduce the risk of potential complications including:

  • Inflammation due to continual irritation
  • Loss of or permanent damage to voice
  • Spread of cancer
  • Spread of infection
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2018 Dec 24
  1. Throat problems. FamilyDoctor.org. http://familydoctor.org/familydoctor/en/health-tools/search-by-symptom/throat-problems.html.
  2. Tips for Healthy Voices. American Academy of Otolaryngology — Head and Neck Surgery. http://www.entnet.org/content/tips-healthy-voices.
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