What is hoarseness, what causes hoarseness and what to do about hoarseness? Hoarseness, also called ‘dysphonia’, is a hoarse change in the normal sound of the voice. The most common cause of hoarseness is a respiratory infection, such as a cold or flu. Hoarseness for which there is no clear cause and which persists for more than two weeks requires further examination by the GP. The underlying cause of hoarseness can be diagnosed by a doctor based on history and physical examination. To get an idea of the cause, the doctor will want to know, among other things, whether the hoarseness started suddenly or gradually developed. A sudden onset of hoarseness often indicates a viral infection or strained voice. The treatment of hoarseness depends on the underlying cause. Hoarseness can be prevented by avoiding excessive vocal use (lots of talking, singing, shouting or coughing) and quitting smoking.
- Persistent hoarseness due to excessive use of the voice
- Sudden hoarseness due to infections
- Upper respiratory tract infection
- Pseudocroup
- Other infections
- Hoarseness due to smoking
- Inhalation of toxic irritants
- Benign hypertrophy (polyp)
- Hoarseness, sore throat and coughing due to cancer
- Autoimmune diseases
- Sarcoidosis
- Scleroderma
- Granulomatosis with polyangiitis
- Reflux
- Medication
- Hoarseness and the thyroid gland
- Disorders of the parathyroid gland
- Parathyroid adenoma
- Hypoparathyroidism (sluggish parathyroid gland)
- Types of hoarseness
- Hypertonic hoarseness
- Hypotonic hoarseness
- Symptoms of hoarseness
Persistent hoarseness due to excessive use of the voice
Excessive vocal use can lead to so-called singing nodules and contact ulcers. People who have to use their voice frequently have an increased risk of developing vocal nodules . These nodules on the vocal cords make your voice hoarse. The nodules can shrink by resting your vocal cords for a few weeks. You do this by speaking little or not at all. Occasionally a biopsy (removing a piece of tissue for examination) and surgical removal are necessary.
Contact ulcers are wounds on the vocal cords. These wounds are often the result of incorrect use of the voice. However, it can also be caused by damage to the vocal cords, for example due to frequent reflux of gastric juice. Slight pain when swallowing or speaking and hoarseness are characteristic complaints. Contact ulcers can be treated by resting the voice, often for longer than six weeks. This gives the wounds the opportunity to heal. It is possible that speech lessons or singing lessons can help to prevent recurrence if incorrect or (unconsciously) forced voice use is the cause.
Cold / Source: Istock.com/gpointstudio
Sudden hoarseness due to infections
Upper respiratory tract infection
A respiratory infection is by far the most common cause of hoarseness. A cold, flu or other respiratory infection can cause the vocal cords to become irritated. The vocal cords may then swell slightly, causing hoarseness. A (viral) infection of the upper respiratory tract, such as a cold, can lead to laryngitis, an inflammation of the larynx. Laryngeal inflammation can cause complaints such as sudden hoarseness or even loss of voice. Other symptoms include:
- a stinging or raw feeling in the throat;
- the constant urge to clear the throat;
- (in severe infections) fever, general malaise, difficulty swallowing and sore throat.
Pseudocroup
An infection such as pseudocroup can also cause a hoarse voice. Pseudocroup is a viral infection of the upper respiratory tract that occurs in young children and causes shortness of breath, audible inhalation and the typical barking cough or seal cough.
Sore throat and hoarseness with laryngitis / Source: Istock.com/ajijchan
Other infections
Other infections that can cause sudden hoarseness include:
- sinusitis: the mucous membrane of the sinuses, usually the paranasal sinuses, is inflamed
- bronchitis: an inflammation in the small tubes of the lungs (the bronchi), the main complaints being coughing and shortness of breath
- epiglottitis: a serious bacterial or viral infection of the epiglottis
- laryngitis with complaints such as fatigue, headache, cough and sore throat
- inflammation of the larynx (laryngitis) with complaints such as sore throat, fever, runny nose, dry cough, hoarse voice
- tonsillitis or tonsillitis
- tracheitis (inflammation of the windpipe)
- tuberculosis (TB)
- uvulitis (inflammation and swelling of the uvula of the tongue)
Quit smoking / Source: Dmytro Zinkevych/Shutterstock.com
Hoarseness due to smoking
Tar in tobacco smoke deposits on the mucous membrane of the respiratory tract (including the vocal cords), which, among other things, has the task of removing dirt (particles). The tar makes this less effective, dirt remains behind and in response extra mucus is produced. This accumulates in your throat and coughing removes it. Coughing irritates your vocal cords and can cause the mucous membranes to swell. The tissue of the vocal cords is thickened, which prevents normal vibration of the vocal cords. Your voice is less clear, possibly even a bit hoarse. Smoking can also lead to chronic thickening of the vocal cords, where tissue fluid accumulates under the mucous membrane of the vocal cords. This makes your voice sound monotonous and hoarse. Stopping smoking ensures recovery of the mucous membranes.
Inhalation of toxic irritants
Inhaling irritants such as smoke or chemicals can lead to hoarseness.
Benign hypertrophy (polyp)
A vocal cord polyp is a benign swelling and is caused by damage to your vocal cord, for example due to excessive or incorrect use of your voice or because your vocal cords come into contact with irritating substances.
Hoarseness, sore throat and coughing due to cancer
Sometimes hoarseness is the result of cancer, for example throat cancer. In addition to a voice change, throat cancer can also cause other complaints:
- Cough;
- Pain or difficulty swallowing;
- Earache;
- A sore throat;
- Lump or ulcer in the throat that does not heal;
- Weight loss.
Thyroid cancer can also cause symptoms such as changes in the voice, including hoarseness and a hoarse voice.
Autoimmune diseases
Sarcoidosis
Sarcoidosis, also called Besnier-Boeck disease, can cause non-caseating granulomas on the vocal cords. The abnormalities often go unnoticed at first.
Scleroderma
Scleroderma is a rheumatic autoimmune disease in which connective tissue thickens or hardens as a result of an inflammatory process. With this condition, the sphincter of your esophagus may no longer work properly due to too much connective tissue, which can cause stomach acid to flow back into the trachea. This can cause complaints such as irritation, especially at night, but it can also lead to coughing fits, swallowing problems or hoarseness.
Granulomatosis with polyangiitis
Granulomatosis with polyangiitis (GPA, previously called Wegener’s disease), is an autoimmune disease of unknown cause. GPA is characterized by inflammation of the inner walls of small blood vessels. Sometimes the vasculitis (inflammation of the blood vessels) can also affect the mucous membrane near the vocal cords. This can lead to hoarseness.
Reflux
More than a million Dutch people suffer from heartburn every day, where the contents of the stomach flow back into the esophagus (= ‘reflux’). This is because the passage from the esophagus to the stomach does not close sufficiently. This can cause symptoms such as acid reflux where you taste the acid that has risen. Other complaints that may arise include:
- A painful, burning sensation behind the breastbone, which can radiate to the neck, back and between the shoulder blades. This is often confused with heart problems.
- An irritated throat and coughing.
- A lump in the throat feeling.
- Farm up.
- Swallowing complaints.
- Hoarseness.
Medication
Occasionally, certain medications (hormones, antihistamines, anticholinergics) can have a hoarse voice or hoarseness as a side effect. Consult your doctor if you suspect that the medications you are taking are causing hoarseness.
Examination of the thyroid gland / Source: Istock.com/KatarzynaBialasiewicz
Hoarseness and the thyroid gland
Hoarseness can be caused by disturbed thyroid function. An underactive thyroid gland (hypothyroidism) leads to delayed cell function, which can cause a range of complaints, such as:
- lethargy and fatigue;
- coldness;
- a reduced sex drive;
- a slower heart rate;
- dry hair or hair loss;
- gloom and depression;
- hearing impairment;
- abnormal weight gain;
- constipation;
- hoarse voice, deeper voice or cracking voice;
- puffy face, swollen eyes and dry, swollen skin, swollen ankles;
- muscle pain and cramps;
- memory loss and concentration disorders.
Disorders of the parathyroid gland
A hoarse voice or hoarseness is sometimes due to a parathyroid gland disorder.
Parathyroid adenoma
A benign tumor can develop in a parathyroid gland, a so-called parathyroid adenoma. Many people with a parathyroid adenoma notice (almost) nothing, but in some people with this condition it does lead to (a range of) complaints.
Shortness of breath / Source: Wavebreakmedia/Shutterstock.com
Hypoparathyroidism (sluggish parathyroid gland)
In hypoparathyroidism, the parathyroid glands work too slowly. This condition is not common. The main complaints are tingling, cramps, fatigue, confusion, shortness of breath, heart complaints and eye complaints, but hoarseness also occurs.
Types of hoarseness
A distinction is often made between hypertonic hoarseness and hypotonic hoarseness.
Hypertonic hoarseness
There is a pinched voice, because the breath encounters too much resistance in the glottis. The vocal cords then close due to the effort you make to make yourself understood. This usually results in complete loss of voice, which is temporary in nature.
Hypotonic hoarseness
The muscles in the glottis are not strong enough due to muscle weakness. It causes the characteristic hoarseness with a lot of breathing noise.
Symptoms of hoarseness
Hoarseness sounds different for everyone: deep, tense, loud, raspy, hoarse, shaking or weak. One vocal cord may be affected, but sometimes both vocal cords. Hoarseness is usually temporary and then disappears spontaneously. However, in some cases hoarseness is a permanent symptom. Hoarseness can develop gradually or suddenly. Depending on the cause, hoarseness may be accompanied by one or more of the following symptoms:
- general:
- vomit
- nausea
- fever
- fatigue
- shortness of breath
- cough:
- coughing up mucus
- dry cough
- chronic coughing
- a smoker’s cough
- throat:
- a lump in the throat feeling
- a dry throat
- mucus in the throat
- swollen vocal cords
- a sore throat
- mouth:
- a dry mouth
- breathing through the mouth
- a sour taste in the mouth
- a salty taste in the mouth
- a bad taste in the mouth
- swollen taste buds
- speech problems
- ears:
- earache
- tinnitus
- nose:
- running nose
- stuffy nose
- sore nose
- tingling nose
- psychological:
- stress
- fear
- social isolation
- depression
- to swallow:
- pain when swallowing
- difficulty swallowing
- regularly swallow the saliva
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