What does this mean?
Your voice is made when two vocal cords vibrate in the airflow. If there is oedema, a nodule, inflammation or a lump on the cords, the pattern of that vibration is disturbed; your voice turns hoarse, cracks, becomes thinner or tires quickly. Hoarseness is therefore not the same thing as a sore throat. Your voice can stay hoarse for weeks without your throat hurting at all.
The point that tells them apart is how long it lasts. Hoarseness caused by an upper respiratory infection usually settles within one to two weeks. Hoarseness that goes past three weeks without ever clearing up in between, or that keeps getting worse, is a separate category and needs to be looked at directly. The vocal cords cannot be judged by an examination from the outside or by a dental X-ray; they can only be seen when an ear, nose and throat specialist looks at them with an endoscope.
The place where this symptom meets the mouth is stomach acid. Acid that reaches the voice box at night both irritates the vocal cords and wears away the chewing surfaces of the back teeth. Hoarseness that is clearest in the morning, a constant need to clear your throat and acid wear on the teeth, all present in the same person, bring this possibility to mind. Smoking and drinking alcohol carry a weight of their own when the cause of hoarseness is being weighed up.
The cause of hoarseness may lie in the vocal cords themselves, or it may come from something outside them that affects them. The headings below gather the possibilities that are commonly considered; only seeing the vocal cords can tell which one applies.
Likely causes
What helps at home?
- Do not strain your voice. Whispering tires the vocal cords too; cutting down how much you talk helps more than whispering does.
- Stay away from smoking and from smoky places. This is the factor that changes the course of the hoarseness, and how urgently it needs assessing, more than any other.
- Drink more water through the day; the habit of constantly clearing your throat and coughing hard irritates the cords over and over again.
- Do not try to treat yourself with over-the-counter sprays, lozenges or leftover antibiotics; they may cover the problem for a while and delay the assessment.
- If the hoarseness has gone past three weeks and has never cleared up in between
- If the hoarseness comes with shortness of breath, a whistling sound as you breathe or difficulty swallowing
- If you have noticed a swelling in your neck that you can feel with your hand and that does not go away
- If you see blood in your saliva or your phlegm
- If you are losing weight without meaning to, or the hoarseness started while you were smoking and drinking alcohol
Frequently asked questions
- Does hoarseness go away on its own?
- Most cases caused by an infection settle within a few days to two weeks. Hoarseness that goes beyond three weeks is not expected to clear up on its own; rather than waiting longer, it is better to have the vocal cords looked at. In people who smoke and at older ages, this waiting time is kept shorter still.
- Is this something a dentist deals with?
- Diagnosing and treating hoarseness belongs to the ear, nose and throat specialist. The dentist's contribution is indirect: when the examination shows acid wear on the back teeth, a dry mouth or bad breath that will not shift, the dentist may recognise the possibility of reflux and point you to the right department, and can also plan measures to protect the teeth from acid.
- I have reflux; is my hoarseness coming from that?
- It may be, but that explanation is not relied on by itself. Stomach acid that comes back up at night can irritate the voice box and cause hoarseness that is more noticeable in the morning. Even so, someone with a diagnosis of reflux may also have a separate problem in the vocal cords; for that reason, when hoarseness goes past three weeks the reflux explanation is not counted as enough, and the cords are still looked at.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.