Hoarse voice

Category: Head, Eyes, Ears, Nose & Throat · All head & senses symptoms

What it can feel like

A hoarse voice sounds rough, croaky, strained or breathy, and may tire or give out altogether. Short hoarseness with a cold is laryngitis — inflamed vocal cords — and settles in days to a couple of weeks. Hoarseness that persists is a different symptom and is always examined.

Possible causes

A symptom can have many causes, and most are not serious. The lists below group conditions this symptom can be associated with — common causes first. They are possibilities to discuss with a clinician, not a diagnosis.

Common causes

Hoarseness can be associated with viral laryngitis, voice overuse, shouting, smoke and dust irritation, acid reflux reaching the voice box, and dry air.

Other possible causes

Hoarseness lasting more than three to four weeks can be associated with vocal cord nodules or polyps, chronic inflammation from reflux or smoking, an underactive thyroid, and — importantly — tumours of the voice box, which are curable when caught early.

Red flags — when to seek help promptly

Hoarseness lasting more than three to four weeks — always get it examined
Hoarseness with difficulty breathing or noisy breathing
Hoarseness with a neck lump, one-sided earache or coughing blood
Hoarseness after neck surgery or a neck injury
Hoarseness in a smoker that does not settle

What a clinician may do

A clinician will ask about voice use, smoking, reflux and thyroid symptoms, and refer for a camera examination of the vocal cords (laryngoscopy) — a brief clinic procedure that shows the cords directly. Thyroid blood tests and reflux treatment may accompany it.

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Frequently asked questions

Why three to four weeks?

Because viral laryngitis has settled by then in almost everyone. Hoarseness beyond that window is no longer assumed to be inflammation — the cords need to be looked at. Early voice-box tumours found this way are often curable with voice-preserving treatment.

Can reflux make me hoarse without heartburn?

Yes — acid and enzymes can reach the voice box, particularly at night, without producing classic heartburn. Hoarseness with throat clearing and a lump-in-throat feeling, worse in the morning, is a recognisable reflux pattern.

Related symptoms — Head, Eyes, Ears, Nose & Throat

Bad breath (halitosis)Bleeding gums Blocked ear feeling Blocked or runny nose Blurred vision Difficulty swallowing

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Please note: This page is educational information about a symptom. A symptom alone cannot diagnose any condition, and the causes listed here are possibilities, not a diagnosis. If you are worried about a symptom — especially one that is new, severe, getting worse or not going away — please see your own clinician, who can examine you and arrange tests. In an emergency, call your local emergency number.