HOARSENESS: WHEN TO WORRY?

Hoarseness, also called dysphonia, is a change in voice quality, strength or the effort needed to speak. It may follow a viral illness or voice strain, but can sometimes reflect a condition affecting the vocal folds or larynx. Duration and associated symptoms determine how soon assessment is needed.

What causes hoarseness?

• Acute laryngitis: often follows a viral infection and causes temporary voice changes.
• Voice strain: shouting, prolonged speaking, singing or inefficient voice use.
• Benign vocal-fold lesions: nodules, polyps, cysts or vocal-fold swelling.
• Reduced vocal-fold movement: sometimes associated with previous neck or chest surgery or neurological conditions.
• Irritants: smoking, inhaled irritants and, in selected cases, reflux.
• Less commonly, laryngeal cancer: particularly with persistent symptoms or additional risk factors.

When is a voice examination needed?

If dysphonia does not resolve or improve within 4 weeks, laryngoscopy is recommended. Assessment should be earlier if a serious cause is suspected, particularly in smokers, after recent neck or chest surgery, with a neck mass, or in a professional voice user with a significant change.

Urgent assessment is needed if hoarseness occurs with breathing difficulty or noisy breathing (stridor). Swallowing problems, coughing blood or unexplained weight loss also require prompt medical review.

How is it diagnosed?

An ENT specialist reviews symptoms and voice use, then examines the larynx with flexible or rigid laryngoscopy. Videostroboscopy may help assess vocal-fold vibration in more detail. CT and MRI are not usually the first investigations before the larynx has been visualised.

What treatments are available?

• Voice care: adequate hydration, avoiding smoking, reducing strain and limiting repeated throat-clearing.
• Voice therapy: can be helpful for selected functional disorders and benign lesions after the larynx has been examined.
• Targeted treatment: depends on the diagnosis and may include treatment of an underlying condition or surgery for selected lesions.

Key message

Most short-lived voice changes are not serious, but persistent dysphonia deserves an accurate diagnosis. Timely laryngoscopy helps prevent unnecessary medication and guides effective treatment.