One may experience a hoarse voice, i.e., one that sounds raspy or forced. Here, one could have talked or sung too loudly earlier or could be experiencing a health issue. Such changes in voice are linked to issues with the vocal folds, which produce sound. The folds come together when speaking or singing, and as air exits the lungs, they vibrate, creating sound. Swelling or lumps in the folds can cause hoarseness.

Causes
Usually, voice can be hampered by swelling or lumps on the vocal folds, with changes in speech quality, volume, and pitch. There can be several causes for the voice to become hoarse, including:

Infection or influenza: The voice may become hoarse due to a cold or upper respiratory illness, such as the flu or other infections. The hoarseness should go away on its own in about two weeks.

Laryngitis or bronchitis: Both laryngitis and bronchitis are inflammatory conditions that can make the voice raspy or muffled.

Cancer: Hoarseness can be a symptom of conditions like laryngeal cancer or esophageal cancer, especially when it persists for longer than three weeks.

Laryngopharyngeal reflux: The condition is frequently mistaken for gastroesophageal reflux disease (GERD). But laryngopharyngeal reflux develops when stomach acid moves up the esophagus and irritates the larynx or vocal box.

Vocal fold hemorrhage: A vocal fold hemorrhage may occur if the voice abruptly disappears or one can speak but not sing. This happens when a blood vessel in vocal folds bursts, allowing blood to seep into the muscular tissues.

Neurological conditions: The area of the brain that regulates the muscles in the pharynx may have been impacted by a stroke or Parkinson’s disease.

Throat polyps, cysts, and lumps: Non-malignant growths like nodules, polyps, or cysts can develop on the vocal folds as a result of excessive strain or friction, leading to hoarseness.

Muscle tension dysphonia: One can experience a shift in how the voice sounds or feels due to overly tight muscles in and around the vocal box. Here, the speech becomes unclear. Laryngitis can cause muscular tension dysphonia, a pattern of muscle stiffness that can persist even after the vocal cord swelling has subsided. Additionally, it can be triggered by stress and coexist with other diseases.

Signs
Hoarseness is itself a symptom but can be characterized by the following changes:

• Unusually weak, breathy, or gruff speech
• Alteration in speech pitch
• Using the voice requires more effort or causes exhaustion

Hoarseness can be accompanied by changes in respiration or swallowing. One may experience other symptoms, depending on the underlying disease causing the changes in voice.

Diagnosis
If one is experiencing hoarseness, the healthcare practitioner might refer them to an otolaryngologist or ENT (ears, nose, and throat) specialist, depending on the symptoms. For an accurate diagnosis, the procedure could involve:

1. Physical examination of the head and neck
2. Laryngoscopy, which involves viewing the larynx with a laryngoscope
3. Vocal cord and throat imaging studies

Doctors typically use a tiny flexible tube (fiberoptic scope) that is passed through the nose to view the vocal folds, or a mirror in the back of the throat can help examine them. The analysis may also benefit from videotaping or stroboscopy.

Management options
The treatment to relieve hoarseness is determined by the underlying cause. Here are common management options doctors might recommend based on the cause:

Strain or overuse: Here, one should give their voice some rest and avoid talking for a bit. One should also have a lot of water to relieve hoarseness.

Sinus-related issue or cold: Here, prescription options can relieve the symptoms. The hoarseness may disappear once the cold is gone.

Other conditions: Doctors can recommend prescriptions and procedures to treat conditions like laryngitis and neurological disorders.

Acid reflux: Here, prescriptions can reduce or prevent acidity.

Vocal fold hemorrhage: The treatment here is complete voice rest or vocal relaxation.

Throat polyps, cysts, and lumps: Changes to meal plans and voice training with a speech-language pathologist are usually recommended. Here, surgery may also be an option. If one is dealing with recurrent respiratory papillomatosis (noncancerous growths similar to nodules), surgical procedures can get rid of the growth.

Vocal fold paralysis: A paralyzed vocal fold may be pushed back towards the center through a straightforward ENT procedure, or a more intensive surgery may be required.

Laryngeal carcinoma: Surgery, chemotherapy, immunotherapy, and radiation therapy are common treatment options for cancer.

Muscle tension dysphonia: Here, treatment consists of voice training with a speech-language pathologist.

If a profession or daily routine requires excessive use of voice, one might require vocal therapy from a speech-language pathologist, especially if they frequently experience hoarseness. One can take up exercises to avoid straining the vocal cords.