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Hoarseness

Hoarseness is not a disease, but a symptom described as abnormal changes to the voice. The voice may sound breathy, raspy, or strained, or there may be changes in volume or pitch. Many conditions can cause hoarseness. The most common cause of hoarseness is acute laryngitis (inflammation of the vocal cords) caused most often by an upper respiratory infection. It can also be caused by overuse or misuse of the voice (such as from yelling or singing).

The treatment for hoarseness depends on the underlying cause. For example, acute laryngitis caused by an upper respiratory tract infection will usually improve on its own as the infection subsides. These infections are usually viral and do not typically require antibiotics.

Conservative treatment with hydration, steam inhalation, and voice rest can be helpful to avoid further irritation or injury to the vocal cords. The use of cough suppressants and decongestants can be helpful but can also have a drying effect, making hydration important. The use of guaifenesin to help mobilize and liquefy mucous is often very helpful. Smoking cessation is strongly suggested for individuals who smoke.

Hoarseness is often caused by acid reflux (GERD). Reflux can frequently be treated successfully by modifying your diet to avoid spicy foods, caffeine, alcohol, and nicotine (cigarettes) and not eating within 2 hours of bedtime. If needed, acid suppression medication, such as a proton pump inhibitor, can be used for a period of time. Occasionally reflux may be severe and resistant to medical management and may require surgical intervention to tighten up loose esophageal sphincters. 

Allergies can also contribute to hoarseness. These allergies can often be treated conservatively with the use of a nasal steroid or nasal antihistamine sprays. The patient can also take oral antihistamines if needed. Allergy testing may help define the specific antigens that are causing the symptoms.

Hoarseness can also be caused by improper use of the laryngeal muscles. This vocal misuse can lead to the development of benign laryngeal lesions such as nodules or polyps. These lesions will often resolve with speech therapy. In cases where these lesions do not improve, microlaryngeal surgery can safely remove these lesions with excellent voice results.

Cancer on the vocal cords can also cause hoarseness. It is important to evaluate hoarseness that persists for more than three weeks to make sure that cancer is not present, especially if the patient has risk factors such as a history of smoking. Cancers that are small and isolated to a limited area of the voice box or vocal cord can often be removed surgically with no need for further treatment.

Hoarseness can also be caused by neurologic conditions such as vocal cord paralysis. This may be spontaneous or may be the result of trauma or a previous surgical procedure. Speech therapy can be helpful in treating these patients. A procedure to help move the vocal cord into a more natural position to achieve better voicing may also be necessary. This can be done by injecting material into the vocal cord. This procedure is generally performed in the office without the need for general anesthesia.

A patient may have other neurologic conditions such as Parkinson's disease which can lead to hoarseness. The UConn Health otolaryngologists work with their neurology colleagues in treating these patients. Speech therapy can be very helpful in improving voice quality.

The patient can also have spasms of the larynx. This condition is called spasmodic dysphonia and can be treated with Botox injections performed in the office.