Voice & Hoarseness

For all of us, the voice is how we interface with the world around us, whether it is socially or professionally. Every person needs to be able to project the voice for normal communication and to modulate the voice for expression of meaning. There are many states that can disrupt the normal voice. Sometimes this disruption is a simple annoyance, and other times it is a devastation that affects relationships and causes disabling issues with jobs. Vocal problems can be frustrating, depressing, and can cause isolation.

Our every day desire is to help restore you to a normal functioning voice so that you can pursue your dreams, whatever they are. In this website you will be able to learn about some of the more common problems that affect the voice as well as a little bit of what to expect from an evaluation when you need help from us with your voice problems.

Click on any of the links below to learn more about this disorder & how it is treated.


What is Hoarseness?

Hoarseness is defined as a roughness or weakness of the speaking or singing voice. It is caused by a disruption of the normal vibration of the vocal cords or by a failure of closure of the vocal cords during vibration. The vocal cords normally work by creating a vibration in the air that flows through them from the lungs, similar to a guitar string when it is plucked. Many things can cause that acoustic signal to become irregular, such as swelling of the cover of the vocal cord from reflux or infection, growths on the edge of the vocal cord, weakness of the muscle that supports the vocal cord, or stiffness from scar.

Hoarseness that lasts longer than a week should be investigated with a procedure to visualize the vocal cords in motion to determine the true cause of the problem. Certain growths on the edge of the vocal cords can lead to severe hoarseness or permanent damage to the voice if not treated early. Often times vocal abuse, or inappropriate patterns of vocal behavior can lead to hoarseness and can be reversed with therapy.

Evaluating Hoarseness

A complete history of the hoarseness, including vocal quality, duration of hoarseness, aggravating or alleviating symptoms, and any other associated symptoms such as cough, postnasal drainage, or sore throat will be helpful to the physician in determining the cause. Medications taken or changed in the recent past should be mentioned as well as any surgery that was performed on the head, neck, or chest area. Any other abnormal sensations such as muscle weakness or difficulty swallowing should be discussed. A history of smoking, even if it was in the past, is important to mention to the nurse or doctor.

The physician will perform a complete head and neck exam, including evaluation of the nose, mouth, neck, and lungs. A special procedure to visualize the vocal cords, called a laryngoscopy, will be performed. This procedure can be done with a camera that is a flexible fiberoptic design, or with a quartz Hopkins scope. Your physician will determine which kind of laryngoscopy would best diagnose your problem. The acoustic signal of the voice may be measured by a special computer program to analyze the specific sound perturbation of the voice.

Many times the exam will be recorded for medical record purposes or to show the patient the abnormality and discuss treatment. If surgical treatment is necessary, step by step instructions will be given to ensure that the patient and family understand the process of recovery and voice rebuilding. Recovery may include speech therapy or special vocal exercises.

Voice Questions & Myths

How Do Allergies Affect Your Voice?

Allergies cause pale, boggy swelling of the vocal folds and can cause the voice to be rough, hoarse, or gravelly. Typically, patients with seasonal allergies will notice a change in their voice during the season that affects them; fall and spring when weed and tree pollen are in high counts are common times that vocal cords can swell. Additionally, postnasal drip onto the vocal cords can cause excessive throat clearing that can lead to vocal injury. Indoor allergens, such as dust mites, can cause a hoarse morning voice or scratchy throat. Allergy testing can tell the difference and immunotherapy (a way to eliminate allergic reactions that works similar to a vaccine) can help singers to optimize their performance during allergy season as well as eliminate drying antihistamines that may interfere with more demanding singing schedules. Click here to learn more about our Allergy Services at the Texas Allergy & Sinus Center.

Is smoking marijuana or using E-cigarettes damaging to the vocal folds?

There aren’t enough studies that show long term effects of the vocal folds using e cigarettes or vaping. Cigarette smoking does show changes of the tissues of the vocal folds. Long term smoking can cause Reinke’s Edema, tissue damage in with the appearance of clear balloon filled gelatin which occurs just below the top layer of the vocal folds. There are many articles to support the effects of smoking tobacco products and vocal fold cancer. One thing to keep in mind is anything inhaled has the ability to change vocal fold tissue. Burning of leaves and inhaling them has more of an effect on your vocal folds than vaporizing. Some evidence has shown that pre-cancerous changes on vocal cords reduce when all marijuana smoking is stopped. Electronic cigarettes contain less carcinogenic ingredients than tobacco; however, there is concern of propylene glycol irritates the respiratory tract. Smoke is smoke so if you are a vocal performer, why risk damaging your vocal instrument by puffing on any type of inhaled substance?

Is it OK to whisper when your voice is strained or you're on vocal rest?

Not entirely. Whispering uses a different technique in the larynx and can cause hyperfunction (increased compressive movement of the vocal folds). This can be a long term habit that is difficult to break.  On occasion using a soft technique of whispering may be beneficial, but forced whispering is not advised.

Do dairy products thicken mucus?

This isn’t always the case. Recent publications have demonstrated that dairy products do nothing to chemically increase mucus production or viscosity. Food allergy or lactose intolerant may cause increased reactions and should be tested.

Are caffeine and alcohol bad for your voice?

This can occur if you overdue it. Caffeine is dehydrating but you would need to drink more than three to five cups a day to cause any dehydration. Some studies show little effect of vocal function with caffeine intake. On the other hand studies have shown that increase water intake is beneficial. Swollen vocal cords don’t function very well. If the vocal folds are not hydrated properly and are taxed, then they can swell. Alcohol is another common myth. Again, how much are you consuming? Sometimes the behavior that occurs while drinking alcohol (talking loud, drinking in a noisy environment, etc.) is more damaging than the mild dehydration of alcohol intake. Remember, when you drink water you aren’t actually spilling fluids on the vocal folds directly. Water will benefit the friction and heat created by your vocal folds by lubricating them. Drink until your urine is clear is usually the motto.

Does hoarseness always mean reflux?

Causes of hoarseness and reflux tends to be over diagnosed. Studies show that patients who visit their ENT with symptoms of hoarseness don’t always have reflux. Proper diagnostic testing to rule out reflux should be performed prior to taking any medications. Hoarseness is a symptom, not a disease. Hoarseness can occur due to many other problems including improper technique, benign lesions including nodules, polyps, cysts, vocal fold cancer, and certain viruses and bacteria. If you have symptoms of hoarseness persists longer than two weeks it is time to schedule a visit with your ENT and Speech Language Pathologist.