Van is a high-pressure basketball coach who typically raises his voice
early and keeps it that level throughout a practice session. He frequently
complains of a sore throat and hoarseness.
Bill Clinton battled hoarseness through both of his campaigns for the
presidency; in 1996 his voice was so weak that he was barely able to give
his victory address.
Most Americans have suffered from laryngitis, usually as a result of
a nasty cold or an afternoon of yelling at a football game. Politicians,
lawyers, professors, ministers, singers and even workers who must shout
over the noise of heavy machinery are also at risk of straining their
vocal cords and suffering the consequences.
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 an upper 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 abuse is a more common cause. Under stress or trying to be
heard above background noise, some individuals raise their vocal pitch,
and 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,
but caffeine should be avoided since it constricts blood vessels and may
cause acid regurgitation.
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 abuse. 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 malignancy–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.
About 7,000 cases of late-stage cancer requiring laryngectomy (complete
removal of the larynx) occur every year. In one study of 73 patients undergoing
laryngectomy, 75 percent reported that hoarseness or a change in the voice
was an early symptom. Other symptoms included weight loss, sore throat
and swallowing difficulties.
Smokers are at high risk, particularly if they are also heavy drinkers
of alcoholic beverages. Four times as many men as women are diagnosed
with vocal cord cancer, but the incidence among women has been increasing
If the cancer is detected early enough, it can be treated with surgery,
laser therapy and/or radiation with a cure rate of 90 to 95 percent. About
75 percent of patients, according to one doctor, regain a normal voice
after laser treatment. Even when surgery is required, a partial laryngectomy
can sometimes be performed, preserving some or all of voice function.
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.
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“A Hoarse Voice,” The Lancet, April 13, 2002.
“Hoarse Voice,” Mayo Clinic Health Letter, January, 1998.
“Hoarseness, Unexplained Voice Changes Can Signal Throat Cancer,”
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Tanveer A. Janjua and Clarence T. Sasaki, “Hoarseness: Just a Cold–Or
Something More Serious?” Consultant, February, 1996.
“Laryngitis: Causes, Treatments Vary,” Mayo Clinic Health
Letter, November, 2001.
Nicholas Mulcahy, “Unexplained Ear, Nose, and Throat Symptoms May
Benefit from GERD Therapy,” Internal Medicine News, July 1, 2001.
Clark A. Rosen, Deborah Anderson and Thomas Murry, “Evaluating Hoarseness:
Keeping Your Patient’s Voice Healthy,” American Family Physician,
“A Word of Warning to Our New President,” Medical Update,