A hoarse voice (dysphonia) is a change in the voice that indicates the vocal cords are not working properly. It is usually caused by excessive voice use, inhaling cold air, or smoking, but it can also be a sign of nerve injury or laryngeal cancer.

In addition to changes in tone or pitch, hoarseness may also cause other symptoms such as shortness of breath, vocal strain, or difficulty recognizing one’s own voice.

If a hoarse voice doesn’t improve or is accompanied by symptoms like weight loss or choking, it’s important to see an ENT specialist (otolaryngologist) or your primary care provider. Treatment depends on the cause and may involve quitting smoking, taking antihistamines or antacids, or having surgery.

woman with hand on throat and eyes close

Common symptoms

The main symptoms of a hoarse or raspy voice include:

Changes in tone or pitch;
A weak or low voice;
Straining to speak;
Difficulty recognizing one’s own voice;
Shortness of breath while talking.

Depending on the cause, other symptoms may also occur, such as coughing, sore throat, burning in the neck, choking, or difficulty swallowing. Identifying these symptoms helps determine the most appropriate treatment.

Can a hoarse voice be a symptom of COVID-19?

Although a hoarse voice is not a common symptom of COVID-19, some people may experience changes in their voice. It is more common to have other symptoms, such as coughing or loss of smell or taste.

Hoarse voice causes

The most common causes of a hoarse voice are:

1. Excessive voice use

Using the voice too much can strain and tire the vocal cords, leading to hoarseness. This is common in people who shout, speak loudly, or clear their throat frequently.

2. Inhaling cold air or smoke

Inhaling cold air or smoke can cause the laryngeal muscles to contract and the vocal cords to become inflamed, leading to temporary hoarseness.

3. Aging

A hoarse voice is common among older adults, especially after age 65, due to the natural thinning and weakening of the vocal cords that occurs with aging. This can affect voice production.

4. Smoking

Smoking can cause hoarseness due to irritation of the larynx from cigarette smoke. When chronic, it can also lead to coughing and fatigue, which may indicate conditions like chronic bronchitis or COPD.

5. Respiratory infections

Hoarseness is often caused by respiratory infections, such as colds or the flu, which irritate the vocal cords. In these cases, hoarseness tends to appear suddenly and is temporary, often accompanied by fever and cough.

6. Allergies

Hoarseness related to respiratory allergies can occur after exposure to dust, mold, or pollen, and usually improves if the allergen is avoided.

7. Gastroesophageal reflux disease (GERD)

Frequent acid reflux can cause hoarseness, along with symptoms such as coughing, sore throat, and chest discomfort. It’s also common to feel a burning sensation in the throat, especially when lying down after eating.

8. Vocal cord nodules

The formation of nodules on the vocal cords can interfere with voice production, causing hoarseness. This is more common in people who use their voice intensively, such as teachers and singers.

9. Chest or neck surgery

Certain surgeries involving the chest or neck can cause a hoarse voice if they damage nerves that control vocal cord movement. In these cases, hoarseness appears shortly after surgery and tends to persist.

10. Laryngeal cancer

Although rare, laryngeal cancer can affect how the vocal cords function, leading to hoarseness. Other symptoms may include choking, weight loss, and difficulty swallowing.

Hoarseness plus cough

When a hoarse voice and cough occur together, they are usually caused by inhaling smoke, respiratory infections like colds or the flu, smoking (especially in chronic bronchitis), respiratory allergies, or gastroesophageal reflux disease (GERD).

Coughing and hoarseness may also be warning signs of laryngeal cancer, particularly in older adults who smoke and experience other symptoms such as weight loss or choking.

Confirming a diagnosis

A hoarse voice is usually identified through noticeable changes in the voice. Diagnosis is confirmed by an ENT specialist or primary care provider, based on symptoms, medical history, and lifestyle habits.

Additional tests, such as a nasolaryngoscopy (which allows direct visualization of the nose, throat, and larynx using a thin camera), may be recommended to help determine the cause of hoarseness.

How to get your voice back

Treatment for a hoarse voice depends on the underlying cause and may include:

1. General care

Some general measures can help, such as resting the vocal cords, quitting smoking, avoiding cold air, and staying away from smoky environments. It’s also important to drink plenty of fluids and avoid beverages that irritate the throat, such as alcohol and coffee.

2. Speech therapy

Speech therapy may be recommended when hoarseness persists and surgery is not necessary. It helps restore normal voice function through specific vocal and breathing exercises.

3. Medications

Depending on the cause, medications that may be prescribed include nasal corticosteroids or antihistamines for allergies, and antacids for acid reflux, such as omeprazole, esomeprazole, or famotidine.

4. Botox injections

In some cases, a Botox injection may be used when hoarseness is caused by vocal cord paralysis or excessive muscle contraction in the larynx.

5. Surgery

Surgery is usually recommended for cases of laryngeal cancer, airway obstruction, or vocal cord problems that do not improve with speech therapy.

6. Home remedies

Home remedies may help relieve symptoms such as sore throat or pain when swallowing. Examples include warm lemon and honey tea or honey and propolis syrup. These remedies may help soothe the throat because of their antioxidant and healing properties.

However, they should not replace treatment prescribed by a doctor. It is also important to note that propolis has not been approved by the FDA as a therapeutic agent.

Hoarse Voice: Symptoms, Causes & Treatment