hoarseness

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

Hoarseness (medical dysphonia) is a common symptom: those affected speak harshly and more softly than usual; sometimes the voice is gone completely. Doctors then refer to this as aphonia. Hoarseness is mostly harmless and temporary. Colds, sore throat or voice overload are often responsible for the rough voice. But smoking and larynx cancer can also be associated with hoarseness. Read everything you need to know about the causes and treatment options for hoarseness here.

Brief overview

Description: rough, thick voice with reduced volume. Hoarseness can be acute or chronic.
Causes: e.g. B. voice overload or incorrect stress, colds, vocal cord nodules or paralysis, tumors on the vocal cords, nerve damage, pseudocroup, diphtheria, acute bronchitis, chronic bronchitis, COPD, tuberculosis, reflux disease, allergies, stress, medication
Home remedies: Depending on the trigger, it can help not to eat too hot or spicy, to drink warm drinks, to suck on lozenges, to put warm neck wraps around the neck, to ensure high humidity; Bach flowers or essential oils can also be used.
When to the doctor For hoarseness that lasts for more than three weeks or keeps coming back, for acute hoarseness without cold symptoms and with a feeling of tightness or shortness of breath, for children, if the hoarseness is accompanied by a barking cough.
Investigations: i.a. Consultation with the patient, physical examination, throat specimen / swab, larynx specimen, tissue removal, blood test, lung function test, gastroscopy, computed tomography (CT)
Therapy: depending on the cause, e.g. with medication, speech therapy or surgery.

Hoarseness description

Hoarseness is caused by pathological anatomical or functional changes in the vocal apparatus: the voice sounds rough or “busy”, the volume is reduced. Sometimes “the voice is gone” (voicelessness, aphonia).

Depending on the duration of the hoarseness, doctors differentiate between acute and chronic hoarseness:

Acute hoarseness: It is mostly due to inflammation of the larynx and vocal cords, as often occurs as part of a cold. It usually subsides after a few days.
Chronic hoarseness: hoarseness that lasts for more than three to four months. It can have many causes, such as vocal cord nodules, vocal cord polyps, or larynx cancer. There are also congenital causes of chronic hoarseness.

Hoarseness: Origin and Causes

There can be many reasons why the voice doesn't sound the way it normally does - harmless as well as serious. The main causes of hoarseness are:

Voice overload or improper strain: If you sing along loudly for a concert evening, your vocal cords will likely respond with acute hoarseness. People who habitually use their vocal cords a lot (such as teachers, singers, call center employees) or who tend to use the wrong vocal technique can even struggle with hoarseness again and again.
Common cold: The common cold is a mostly harmless infection of the upper respiratory tract with viruses. It is usually accompanied by a runny nose, hoarseness, nasal congestion, cough and possibly a slight fever.
Pharyngitis: Hoarseness is often caused by inflammation of the lining of the throat. Acute sore throat usually occurs as part of a cold. It is usually harmless and heals quickly with bed rest, home remedies and, if necessary, painkillers (for the sore throat). If the pharyngitis lasts longer than three months, it is considered chronic. Triggers are external, mucous membrane-damaging factors such as heavy smoking or radiation therapy (in cancer).
Laryngitis (laryngitis): Acute laryngitis often accompanies a cold. It triggers acute hoarseness (sometimes up to voicelessness), throat clearing, coughing, burning and scratching in the throat and possibly fever. Chronic laryngitis can be caused, for example, by smoking, frequent inhalation of dust or dry air, chronic voice overload, alcohol addiction or vocal cord nodules. Sometimes it is a side effect of medications such as antidepressants.
Vocal cord polyps: Polyps on the vocal folds are benign changes in the mucous membrane. They usually develop after an acute laryngitis, if the patient has not kept the vocal calm recommended by the doctor. The hoarseness persists even after the larynx has subsided. By the way: Smoking favors such polyps.
Vocal cord nodules ("singer's nodules", "screaming nodules"): Frequent speaking, singing or screaming, incorrect breathing, cigarette smoke, dry air - there are many factors that can overstrain and irritate the vocal cords. The mucous membrane swells at the most stressed area (usually in the middle of the vocal folds). With continued overuse, the swelling can develop into a nodule that causes hoarseness. If the voice is spared and trained accordingly, vocal cord nodules can disappear again.
Vocal cord paralysis (recurrent palsy): The vocal cord paralysis (vocal cord paralysis) is often one-sided and is accompanied by hoarseness. It is triggered by damage to the nerve that is important for the functioning of the vocal apparatus (recurrent nerve). For example, the nerve can be injured in the course of a thyroid operation (or other operations in the neck area) or constricted by space-occupying processes (such as larynx tumor, sarcoid, aortic aneurysm). In addition, viral infections (such as flu, herpes infections), toxins (such as alcohol, lead), rheumatic diseases and diabetes can cause nerve damage with paralysis of the vocal cords and hoarseness. Sometimes the cause of the paralysis remains unexplained.
Pseudocroup: As part of a laryngitis, the larynx outlet can swell strongly, especially in babies and toddlers. As a result, in addition to acute hoarseness, barking coughs and shortness of breath occur. Doctors speak of pseudo croup or croup cough. In the event of severe coughing attacks with shortness of breath, call the emergency doctor immediately!
Epiglottitis: In rare cases, hoarseness can indicate inflammation of the epiglottis. However, the following symptoms of epiglottitis are much more characteristic: sore throat, pain when swallowing, severe sore throat, high fever and above all shortness of breath - it can very quickly turn into life-threatening attacks of suffocation!
Diphtheria (true croup): This highly contagious infectious disease is caused by bacteria. The pathogens primarily cause inflammation in the nasopharynx. This pharyngeal diphtheria can develop into larynx diphtheria with symptoms of hoarseness, voicelessness and a barking cough. In addition, breathing problems increasingly occur, including the risk of suffocation.
Acute bronchitis: Acute bronchitis is an inflammatory infection of the respiratory tract caused by viruses or (less often) bacteria. It is very common and, in addition to hoarseness, also causes fever, cough, pain behind the sternum and headache, muscle pain and aching limbs.
Chronic bronchitis: In chronic bronchitis, the bronchi are not only temporarily inflamed (as in acute bronchitis), but permanently. Men are particularly affected, primarily smokers and ex-smokers. In addition to hoarseness, chronic bronchitis is mainly characterized by a chronic cough with thick sputum.
COPD: Chronic bronchitis can lead to a narrowing (obstruction) of the bronchi over time. If this chronic obstructive bronchitis is combined with pulmonary bloating (pulmonary emphysema), doctors speak of COPD. Those affected mainly suffer from chronic coughing, phlegm and shortness of breath. Hoarseness can also occur.
Enlargement of the thyroid gland (goiter, goiter): The thyroid gland can be enlarged for various reasons, for example due to iodine deficiency, disorders of iodine utilization, disorders of hormone synthesis in the thyroid or benign or malignant tumors. Possible symptoms of a goiter are hoarseness, difficulty swallowing, shortness of breath and a tightness in the throat.
Underactive thyroid (hypothyroidism): An underactive thyroid can also be associated with hoarseness. Other symptoms include weight gain, tiredness, dry and flaky skin, dry and brittle hair, constipation and goiter. Hypothyroidism can be congenital or acquired.
Tuberculosis (consumption): Tuberculosis (TB) is a chronic bacterial infectious disease that can affect the larynx (larynx tuberculosis) - either alone or in addition to the lungs (pulmonary tuberculosis). The main symptoms of larynx tuberculosis are hoarseness and difficulty swallowing. In addition, there is often a cough and weight loss.
Reflux disease: Under reflux disease (gastroesophageal reflux) medical professionals understand the reflux of acidic stomach contents into the esophagus. In addition to typical symptoms such as heartburn, reflux disease can also cause hoarseness.
Laryngeal cancer: Larynx cancer is the main problem with heavy smokers, especially if they consume a lot of alcohol at the same time. Symptoms of this malignant tumor include persistent hoarseness with difficulty swallowing, sensation of a foreign body, and coughing up blood.
Food allergies: Hoarseness is one of the possible symptoms of a food allergy (for example peanut allergy), in addition to swelling of the oral mucosa, skin rash, tears, etc.
Mental stress: Sometimes acute or chronic mental stress triggers hoarseness. Fear, excitement, depression and lovesickness can be to blame if suddenly the voice is gone.
General weakness: People who are generally weak because of their old age or serious illness often have hoarse, powerless voices.
Injury to the larynx: External injuries such as bruises or choking can result in acute hoarseness; sometimes the voice is gone temporarily.
Side effects of drugs: Cortisone sprays, such as those often used by asthma patients, can cause hoarseness and fungal infections of the oral mucosa (oral thrush) as side effects. Other medications such as allergies (antihistamines) and depression (antidepressants), water tablets (diuretics) and female sex hormones (estrogens, for example in hormonal contraceptives) can cause hoarseness.

This helps against hoarseness

The treatment will vary depending on how pronounced the hoarseness is, how long it has lasted, and how likely it is that it is caused by a serious illness.

This is how the doctor can treat hoarseness

If the doctor has diagnosed a treatable disease as the cause of the hoarseness, he will initiate appropriate therapy. It can include, for example, the administration of certain medications (for example for laryngitis) or speech therapy (speech therapy, for example for overloading the vocal cords or vocal cord nodules). Sometimes surgical interventions are also necessary (for example in the case of larynx cancer, vocal fold polyps).

Home remedies for hoarseness

Gentle: In the case of hoarseness due to overuse of the voice, the first thing to do is to take care of yourself. So talk as little as possible!
Speak low-loud: Many people begin to whisper when they are hoarse, but this only strains the vocal cords. On the other hand, speaking in a low voice is permitted.
Keeping a "diet": If acute or chronic laryngitis is to blame for the hoarseness, you should follow the "larynx diet": Do not eat too hot or too spicy. Avoid cold food (such as ice cream) and drinks. Do not smoke or speak too much (be careful with your voice!). These tips also don't do any harm if the hoarseness has other causes than laryngitis (such as sore throat or vocal cord nodules).
Warm drinks: Drink plenty of warm drinks if you are hoarse. In the case of acute laryngitis, a tea mixture of 50 g of fern frond (Herba Adiantis capillis veneris), 20 g of mallow leaves (Folium Malvae sylvestris) and 30 g of thyme (Herba Thymi vulgaris) is recommended. Drink five cups of this tea a day.
Ribwort plantain tea: Ribwort plantain tea can also relieve hoarseness: Pour 250 ml of hot water over two teaspoons of the tea and let it steep for 15 minutes. Drink a cup twice a day. You can gargle with the tea as well.
Ginger tea: It is also suitable as a remedy for hoarseness: drink several cups a day or gargle with it.
Inhalation: Chamomile, fennel and peppermint teas are effective for inflammation of the throat, which is often associated with hoarseness. Inhale the vapors of the hot tea before drinking it.
High humidity: If you are hoarse, make sure that there is sufficient humidity in the room. The above-mentioned inhalation is also good for the throat and vocal cords - either just with hot water or you can add some salt or medicinal herbs (chamomile, fennel, etc.) to the water.
Fennel milk: Fennel milk is also a popular remedy for hoarseness due to a sore throat: To do this, boil 3 teaspoons of fennel seeds with half a liter of milk; then strain and sweeten the milk with honey.
Suck yourself healthy: Adults and older children who suffer from hoarseness and sore throats can use sucking preparations with sage or Icelandic moss.
Neck wrap: For hoarseness due to colds, sore throat or other throat infections, you should keep the neck area evenly warm: Put a scarf on and / or make a neck wrap for a sore throat, for example a warm potato wrap: Boil potatoes, mash, in wrap a cloth and place it on the neck (check temperature!). The compress stays on the neck until it has cooled down.
Staying abstinent: No matter what the cause of the hoarseness is - refrain from alcohol and avoid smoky and dusty rooms.
Homeopathy: Homeopathic remedies that are recommended for hoarseness are for example Ferrum phosphoricum 30C (Laryngitis and dry hoarseness), Carbo vegetabilis 30C (Hoarseness in the evening), Causticum D12 and Spongia D6 (in the case of hoarseness due to overexertion of the vocal cords). Patients with hoarseness, dry cough, sore throat and fever with shivering will often Drosera given. You should speak to a homeopath about the dosage and frequency of use.
Bach flowers: If you want to try Bach flower therapy for hoarseness, you should do it several times Star of Bethlehem ingestion, a perennial herbaceous plant (also called umbelliferous milk star).
Essential oils: Aromatherapy uses essential oils such as eucalyptus, spruce needle, marjoram, rosemary and thyme oils to treat cold symptoms such as hoarseness, coughs and runny nose - either by rubbing in or inhaling.

Before using essential oils on children, you should consult with a therapist or doctor. Because some essential oils such as eucalyptus oil, mint oil or camphor can cause cramps in the respiratory muscles in small children with a risk of suffocation!

Hoarseness: when do you need to see a doctor?

The hoarseness often goes away on its own or thanks to home remedies. In the following cases of hoarseness, however, a visit to a doctor is urgently recommended:

Hoarseness that lasts longer than three weeks - especially if you have no idea what the cause is (suspected larynx cancer!)
recurring hoarseness, especially with prolonged voice strain
acute hoarseness to voicelessness if there are no symptoms of a cold but increasing tightness or shortness of breath
acute hoarseness and barking cough in the child

On the other hand, there is usually no need to worry about hoarseness in male adolescents: a rough, thick voice at the beginning of the voice break is normal.

Hoarseness: what does the doctor do?

To find out what caused the hoarseness, the doctor will first ask you about your medical history (anamnesis). Important information is for example:

How long has the hoarseness been there?
Are there accompanying symptoms such as throat clearing, cough, shortness of breath or fever?
Do you smoke?
Do you drink alcohol frequently?
Are there any chronic diseases such as asthma?
Are you taking any medication?
What is your job (for example a voice-damaging job such as a teacher, opera singer)?

Important examinations for hoarseness

From this information, the doctor can usually guess what might have caused the hoarseness. Further examinations can confirm the suspicion:

Physical examination: This is routine when working up hoarseness and especially indicated when the common cold, acute bronchitis and asthma are possible causes of hoarseness.

Pharyngoscopy: The doctor examines the throat using a small mirror or a special endoscope (a tubular medical instrument) if he suspects an inflammation of the throat as the cause of hoarseness.

Throat swab: If the acute bacterial infectious disease diphtheria is a possible cause of hoarseness, the doctor takes a throat swab with a spatula to create a bacterial culture. If diphtheria bacteria can actually be grown from the smear, this confirms the doctor's suspicion.

Laryngoscopy: An endoscopic examination of the larynx is performed if, for example, laryngitis, epiglottitis or larynx cancer is suspected to be the cause of the hoarseness.

Biopsy: As part of the larynxoscopy, the doctor can also take a tissue sample (biopsy) if he discovers suspicious cell growths (tumors), for example on the vocal cords or on the larynx.

Examination of the sputum (sputum examination): The patient's sputum is analyzed with regard to color, smell, consistency, composition, etc. if the doctor suspects acute bronchitis as the cause of hoarseness.

Blood samples: A blood sample from the patient is examined for relevant infectious agents if chronic bronchitis or tuberculosis is suspected. In addition, a blood test with recording of the hormone status (thyroid hormones) is used to diagnose hypothyroidism as the cause of hoarseness.

X-ray examination: An X-ray examination is used, for example, to clarify asthma, chronic bronchitis, COPD and tuberculosis as possible causes of hoarseness.

Lung function test: A pulmonary function test using spirometry reveals whether bronchial asthma is possibly causing the hoarseness.

Gastroscopy (esophago-gastroscopy): A look with the endoscope into the esophagus and stomach shows whether a backflow of acidic stomach contents into the esophagus (reflux disease) is behind the hoarseness.

Ultrasound examination (sonography): In the ultrasound image, the doctor can identify an enlarged thyroid gland (goiter, goiter) as the cause of hoarseness.

Computed tomography (CT): Computed tomography is used to clarify tumors (such as larynx cancer) as possible causes of hoarseness. In addition, CT is used if vocal cord paralysis is suspected.

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