Hoarseness is a symptom that points to pathology in upper part of respiratory tract, more specifically in the area of vocal cords. Mostly it is a temporary disability of vocal cords during viral infections, but even more serious causes exist. Hoarseness lasting more than three weeks should therefore be a reason for medical consultation.


In the beginning we should have basic information about vocal cords. The vocal cords are two ligaments stored in larynx inside the throat. The larynx is a part of upper airways. It is separated by from nasopharynx by a closable flap called epiglottis that prevents food or fluid entry into larynx and lower respiratory tract. During exhalation, flowing air vibrate the vocal cords and that allows a primary formation of voice.



Laryngitis is a common infectious disease that affecting the larynx. It is usually acute condition lasting few days and it is caused by different viral strains. Virus attack is connected with swelling of laryngeal mucosa including the vocal cords. In addition to hoarseness, raspy voice and sore throat, the disease manifests with flu-like symptoms such as fever, fatigue, muscle pain and joint pain. Acute laryngitis is probably the most common cause of hoarseness and usually subsides within a week.

Vocal cords overload

Hoarseness occurs when overloading voice. Temporary hoarseness usually follows a single overstraining of voice in untrained individuals (cheering by a game, singing in a pub). On the other hand, even vocally trained individuals, i.e. singers, may begin to suffer from hoarseness after many years of singing. Long-term stress of the vocal cords may cause their chronic changes –tissue thickening and small growths appearance. These changes can permanently change the voice quality including permanent hoarseness.

Worse quality of inhaled air

It is more difficult to breathe dry air for longer time as it irritates our airways. The situation is worse when there are pollutants present. Tobacco smoke is especially harmful. These factors can cause chronic laryngitis and bronchitis that manifest with recurring voice hoarseness and productive cough.

Throat cancer

Laryngeal cancer may also be responsible for hoarseness; in fact this is its most feared cause. It is typical for smokers and alcohol drinkers Tumor mass infiltrating the larynx may invade the vocal cords. It should be noted that there are more types of cancer of the larynx and hoarseness in early phase of the disease is accompanied by only some of them. It is a positive attribute, because it makes possible to find the cancer in a treatable stage. Cancer of the larynx is precisely the reason why hoarseness lasting longer than three weeks shall never be underestimated!

Hoarseness caused by a doctor (Iatrogenous hoarseness)

Hoarseness may occur after all surgical interventions in the neck area, there is especially a high risk in thyroid gland operations. The essence of problem is violating nerves controlling vocal cords muscles causing their paralysis. The nerve is called recurrent laryngeal nerve. It is extremely sensitive and can be irreparably damaged only by their close proximity to the operating area. Therefore, a risk of permanent damage to the voice accompanies even the most cautiously performed neck operations.

Diagnostic approach

When there is prolonged hoarseness present, it is advisable to undergo by otolaryngologist who can examine nasopharynx and upper part of larynx including vocal cords by using special instruments. In case of tumor suspicion imaging methods may be used as computed tomography of the neck to clearly show the size and extent of the tumor.


If throat cancer is the cause of hoarseness, surgical treatment is performed, if possible. Sometimes it is complemented by radiation and chemotherapy. Surgery (minor surgery) is used to solve benign nodules that can appear on vocal cords of singers. If we want to cure hoarseness as a symptom, we have a number of more or less effective means. It is important not to irritate the vocal cords. Voice calm is essential; inhalation of warm humid air also helps. Mucolytic drugs are used to dissolve mucus and to cough it out.

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources