Why Am I Hoarse?

by William Z. Gao, MD, Laryngologist
May 28, 2020

Like the Beach Boys, your vocal cords appreciate good vibrations. But illness or vocal trauma can affect the vibrations in your voice box (larynx), resulting in hoarseness—or, in some cases, a complete loss of voice. So, why does this happen?

Colds and Infections May Affect Your Voice

One of the most common causes of damage to the vocal cords is viral infections like the common cold. In those situations, you can experience inflammation and swelling in the throat. When swollen, your vocal folds (vocal cords) become stiffer than normal and don’t vibrate as well. You may then experience different degrees of hoarseness (rough or raspy) because the two sides are vibrating at different frequencies. When we say we’ve lost our voice (aphonia), the stiffened vocal folds may be so swollen that they don’t vibrate, which prevents us from getting any sound out.

While hoarseness is a symptom, laryngitis refers to inflammation of the larynx. Laryngitis may arise from viral infections as mentioned or, more uncommonly, bacterial or fungal infections. Those with weakened immune systems may be more prone to these infections. Fungal laryngitis is also more frequently seen in people on steroid inhalers such as those with asthma.

When we become hoarse or lose our voice, it can be from a number of causes including the common cold and vocal overuse. @WilliamGaoMD explains when to get help. bit.ly/2TIQLqE @MedStarWHC @MedStarGUH @MedStarHealth
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Why Does My Voice Get Hoarse the More I Use It?

Vocal overuse (phonotrauma) is a common cause of hoarseness, especially in people with a greater need to use their voice, or in those who stress their voice box—for example, by cheering, yelling, or coughing repeatedly. Our vocal folds normally vibrate anywhere from 100 to over 200 times per second when we speak. When those vibrations are multiplied over the course of a day, we may generate millions of vibrations per day.

This high degree of sheer stress on the vocal folds can cause problems. We tend to notice it reflected in the quality of our voice the next day, when we wake up. Fortunately, though, permanent damage doesn’t typically occur from a single incident. However, repeated injury to your vocal cords can lead to the development of various vocal fold lesions ranging from nodules to polyps to cysts. Continued injury can even lead to scar tissue, which is a difficult problem to address and may cause permanent hoarseness.

Vocal Health: Tips to Preserve Your Voice

How can you protect your voice? It’s a matter of how you use it, and optimizing conditions for using the voice. Vocal hygiene is frequently overlooked, but it plays a big role in safeguarding your voice.

These tips can help:

  • Avoid hurtful behavior: It’s key to “respect the instrument.” Use your voice in a way that’s not damaging. Avoid yelling, repeated coughing, and throat clearing as they cause the vocal cords to slam together, which can be quite traumatic to them.
  • Hydrate: The vocal cords require adequate moisture and lubrication in order to vibrate well. So be sure to drink plenty of water! Avoid excessive sweet, carbonated, and caffeinated beverages as they may not be as hydrating or may even be dehydrating to drink.
  • Pro tips: In line with ensuring adequate hydration, singers often find it helpful to use a humidifier and/or facial steamer. It is also important to avoid laryngeal irritants such as smoke, dust, and environmental allergens that may be more prevalent in some areas.
  • Voice rest: If you’ve been dealing with a hoarse voice, it may be beneficial to reduce how much you use it or even go on complete voice rest. As hard as it is to do, you’ll likely find that the silence is restorative to both mind and body. Even a day of voice rest can improve the voice, but longer periods up to a week may be needed.
  • Use it or lose it: The voice changes as we get older and move into the golden years. I see patients in their 60s and beyond who start to notice more troubles with the strength of their voice that is related to thinning or atrophy of the underlying muscle in their vocal cords. Preserving and restoring the voice in these cases relies on using it more!

To Speak or Not to Speak

Hoarseness that continues for more than two to four weeks means it’s time to be evaluated. There are many different medical conditions beyond the common cold and vocal overuse that can cause hoarseness. These include acid reflux, neurologic problems like paralysis, and even cancer of the voice box. It is important to get an accurate and timely diagnosis to ensure a favorable outcome. If issues persist, it is helpful to schedule an appointment with a specialist, such as an otolaryngologist, also known as an ear, nose, and throat (ENT) doctor, or even an ENT who specifically specializes in voice disorders. They can determine the underlying cause of hoarseness, and provide the optimal treatment, whether medical or surgical.

Patient-Centric Multidisciplinary Approach

Care of the voice—especially care of the professional voice—involves a team approach at MedStar Health. We can bring you the perspective and expertise of specialists across different disciplines to provide the best treatment. If your voice disorder stems from a medical condition, we engage with experts such as gastroenterologists, pulmonologists, and neurologists, depending on the cause. Additionally, speech-language pathologists or voice therapists are instrumental to vocal rehabilitation, as they are experienced in administering voice therapy, which is like “physical therapy” for the throat and voice box.

At MedStar Health, our aim is to help you enjoy a healthy voice for a lifetime.

Hoarse voice?

Our specialists can help.

Call 202-644-9526 or  Request an Appointment

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