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Evaluate hoarseness that doesn’t go away
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Evaluate hoarseness that doesn’t go away

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DEAR MAYO CLINIC: For the past few weeks, I have had a hoarse voice, even though I don’t have a cold. Is this something I should be concerned about?

ANSWER: It’s not uncommon to experience hoarseness once in a while, especially with a cold or even after cheering loudly at a sporting event. But when a hoarse voice doesn’t go away after three to four weeks, it’s a good idea to see your health care provider. That’s because hoarseness can be more than a temporary nuisance and result from numerous treatable problems.

Your voice is created when air from your lungs flows up through the vocal cords — also called vocal folds — in your voice box, or larynx. The vocal cords are made up of layers of delicate tissue from an elastic surface to deeper tissue of muscle, all within a cartilage framework. As air passes through the vocal cords, they vibrate, producing sound. Alone this sound is similar to a buzzing sound, but when the sound travels through your vocal tract, throat, mouth and nose, you shape this sound into speech.

Laryngitis is when the vocal cords are swollen and inflamed, a common cause of hoarseness. Most cases of laryngitis come on quickly and are cleared up in a few days to two weeks. Most often, laryngitis is associated with a viral respiratory infection, such as a cold, or extended periods of talking or singing. In the case of respiratory infections, simple self-care tips that may help healing include drinking plenty of liquids, using throat lozenges or hard candy, and resting your voice for a few days. When laryngitis is because of talking, singing or yelling at a sporting event, self-care also may help. This is considered phonotrauma and can cause long-term and even permanent damage if the situation is repeated.

When hoarseness lasts more than three weeks, or if you have other worrisome signs or symptoms such as a lump in your neck, pain when speaking or difficulty swallowing, it’s time to see your health care provider. That’s because the list of potential causes grows much larger.

Your health care provider will review your medical history, symptoms and any potentially triggering factors. A visual inspection of your vocal cords may be performed with a mirror or using a small camera attached to a thin, flexible tube.

The quality of your voice also may be evaluated. For example, your voice may sound breathy or weak, or have a tremor quality that may offer clues to the source of the medical problem. In some cases, tests used to measure voice irregularities, airflow and other characteristics can help reach a diagnosis.

When laryngitis lasts longer than a few weeks, it’s considered chronic. This may be due to ongoing infection, smoking, allergies, other irritants, persistent vocal strain or reflux. Certain medications also can affect your voice.

Hoarseness due to chronic laryngitis typically improves by eliminating the underlying cause. This may mean not smoking; learning to use your voice more efficiently; and treating any allergies, reflux or other infection.

If medications seem to be the culprit, ask your health care provider for ways to minimize this side effect. For example, if you are using a discus type inhaler for asthma, you may benefit from using a spacer to reduce depositing of the medicine in your throat instead of your lungs. Also if you use an inhaler, it is important to gargle and rinse your mouth after use. Angiotensin converting enzyme inhibitors, commonly known as ACE inhibitors, can cause throat irritation and dry cough. Many other medications can cause dryness.

Hoarseness also can be caused by noncancerous growths along the vocal folds. These include small vocal cord swellings (polyps), calluslike patches (nodules) or small encapsulated lesions (cysts). These may be due to phonotrauma, and smoking and reflux can be contributing factors. Lesions often heal by eliminating irritants, and with voice therapy. Surgery may be needed to remove persistent lesions.

Aging is another factor that can affect your voice. Vocal cords can naturally lose some tone and fullness as you age, often resulting in your voice sounding breathy or weak. Voice therapy is a common treatment, but if these changes greatly impair your ability to communicate, your health care provider may recommend a surgical procedure in which an injection is used to add bulk and fullness to your vocal cords.

Other causes of hoarseness include vocal cord spasm; complications of other conditions that affect areas of the brain that control muscles in the throat or larynx, including Parkinson’s disease and multiple sclerosis; and cancer.

Because your hoarseness has lasted for more than three to four weeks, I recommend that you be evaluated by your health care provider, who will likely send you to see an ear, nose and throat doctor. Your care team can get to the root of the problem and offer treatment options based on the underlying cause.

(Mayo Clinic Q & A is an educational resource and doesn’t replace regular medical care. E-mail a question to MayoClinicQ&A@mayo.edu. For more information, visit www.mayoclinic.org.)

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