What to Do If Your Voice Is Hoarse

Dysphonia, or hoarseness, affects approximately one-third of people under the age of 65 during their lifetime. This climbs to nearly 80 percent for high vocal users—like teachers and singers—and those over the age of 65. Symptoms of dysphonia include vocal fatigue, pitch changes, voice breaks, unintended volume changes, increased vocal effort, and decreased quality.

Hoarseness can range from temporary voice changes caused by a viral infection to a severe disability that makes basic communication difficult.

If you are seeking medical care for hoarseness, you doctor can now consult the updated Clinical Practice Guideline: Hoarseness (Dysphonia). Recently released by The American Academy for Otolaryngology-Head and Neck Surgery, the Clinical Practice Guideline details how your doctor can best treat this often irritating condition.

Matthew C. Mori, MD, Assistant Professor of Otolaryngology-Head and Neck Surgery at the Icahn School of Medicine at Mount Sinai and a laryngologist at the Grabscheid Voice and Swallowing Center, offers answers to some of the most frequently asked questions.

When should I see a health care provider about my hoarseness?

According to the recent Clinical Practice Guideline: Hoarseness (Dysphonia), you should see a health care provider if:

• Your hoarseness does not go away or get better in 7-10 days. (It’s especially important to see a doctor if you are a smoker.)
• You do not have a cold or flu
• You are coughing up blood
• You have difficulty swallowing
• You feel or see a lump in your neck
• Your loss of, or the severe changes in, your voice last longer than a few days
• You experience pain when speaking or swallowing
• Your voice change comes with uneasy breathing
• Your hoarseness makes your work hard to do
• You are a vocal performer (singer, teacher, public speaker) and cannot do your job

Do I need antibiotics, steroids, or imaging (such as an X-ray, CT scan, MRI)?

Maybe. However, except for some special cases, you will not need medications or imaging before a specialist looks at your vocal cords or larynx. The Clinical Guidelines recommend against these routine treatments prior to examination of the larynx. However, after an in-office laryngoscopy (examination of the larynx or vocal cords), one or more of these treatments may be prescribed. Acute hoarseness is often caused by laryngitis from a viral infection, making antibiotics ineffective. Additionally, corticosteroids should be avoided unless indicated due to the risk of rare, but serious, adverse effects.

What is voice therapy?

Voice therapy is a well-established program to treat many causes of hoarseness. It involves a trained speech language pathologist guiding you through voice and physical tasks as well as behavioral changes to help you shape healthy vocal behavior and attain the best possible voice. Voice therapy is the first-line therapy for behavior-related vocal lesions like vocal nodules and polyps. With few exceptions, it is covered under insurance.

Do I need surgery to treat my hoarseness?

This depends on the cause of the hoarseness. Lifestyle changes and voice therapy may be enough. But some patients may need surgery to improve the voice due to benign vocal cord lesions—like cysts or polyps—which have not responded to more conservative treatments. Also, if there is a paralysis of the vocal cord, or a form of muscular weakness known as paresis, an injection or implant may be required. If there is a possibility of a malignancy or cancer, surgery or an in-office biopsy would be required to make a diagnosis.

Is it better to wait to see if my hoarseness goes away on its own?

If your voice has not improved after 7-10 days, you should be evaluated by a health care provider. With any problem of the vocal cords, the earlier you start treatment the better.

If your hoarseness persists for more than four weeks, you should be seen by an otolaryngologist, also known as an ear, nose, and throat (ENT) surgeon.