By Dr. Laureano Giraldez-Rodriguez, MD, FACS
We’ve all experienced hoarseness at some point. Maybe after a concert, a game where you cheered without stopping, or during a bad cold. In those cases, the hoarseness disappears within a few days and life goes on. But what happens when that hoarseness lingers for weeks or even months? That’s exactly what many patients bring to my office, and it’s a concern that deserves attention.
Here we’ll talk about chronic hoarseness: what causes it, when you should seek help, and what options exist to get your voice back.
What is hoarseness and why does it happen?
Hoarseness, or dysphonia, is any change in the quality of your voice. It can sound raspy, weak, breathy, or simply different from usual. Your voice is produced when air from your lungs passes through the vocal cords in the larynx, causing them to vibrate. Anything that disrupts that vibration changes your voice.
The most common causes of temporary hoarseness include viral upper respiratory infections, vocal overuse, and allergies. These situations usually resolve on their own within one to two weeks. The problem arises when hoarseness persists beyond that period.
When should I be concerned?
If your hoarseness lasts more than two to three weeks without improving, you need a medical evaluation. It doesn’t matter if you think “it’ll go away eventually” or if nothing hurts. There are several reasons hoarseness can become chronic, and some require early intervention for better outcomes.
Among the causes of persistent hoarseness are vocal nodules, benign calluses that form on the vocal cords from excessive or improper voice use. There are also vocal polyps, similar lesions that are usually one-sided and may require surgical treatment. Laryngopharyngeal reflux is another frequent cause, where stomach acid rises up to the throat and irritates the vocal cords without you necessarily feeling heartburn.
Vocal cord paralysis is a condition where one or both vocal cords stop moving properly, affecting not only the voice but potentially breathing and the ability to swallow. And although less common, we can’t fail to mention that persistent hoarseness can be an early symptom of laryngeal cancer, especially in people with a smoking history.
How is chronic hoarseness evaluated?
The most important step is laryngoscopy, a procedure in which a flexible camera is passed through the nose to directly observe the vocal cords. It’s a quick procedure, usually lasting less than a minute, and it gives us invaluable information about the condition of your larynx.
What are the treatment options?
Treatment depends entirely on the cause. For many benign conditions like early vocal nodules or hoarseness from vocal misuse, voice therapy with a speech-language pathologist is the first step. This therapy teaches you techniques to use your voice more efficiently and healthily.
For lesions such as polyps or cysts, a surgical procedure called microlaryngoscopy may be necessary, using microscopic instruments to remove the lesion while preserving as much healthy tissue as possible. When it comes to reflux, we combine lifestyle changes with medication when needed.
In cases of vocal cord paralysis, we offer laryngeal injection procedures that can significantly restore vocal function. And if we detect anything suspicious, we perform biopsies to rule out malignancy and act quickly if necessary.
Don’t ignore your hoarseness. If you’ve had changes in your voice for more than two weeks, don’t wait any longer. A timely evaluation can make all the difference.
