The human voice is produced when air passes through the vocal cords, causing them to vibrate. Each person's voice is unique, shaped by factors such as the length, thickness and tension of the vocal cords, as well as the mouth and nasal cavities.
According to Christos Gkionis, Director of Otolaryngology at Metropolitan Hospital, hoarseness is any abnormal change in the voice caused by dysfunction of the larynx or problems affecting the vocal cords and their closure.
Common Causes of Hoarseness
Visible Vocal Cord Abnormalities
These include:
- Acute laryngitis and inflammation, often following viral or bacterial respiratory infections. This is the most common cause and usually resolves within a few days.
- Chronic inflammation and Reinke's edema, often linked to smoking, excessive alcohol consumption and improper voice use.
- Vocal cord polyps.
- Vocal cord nodules ("calluses"), common among professional voice users such as singers, actors, lawyers and priests.
- Allergy-related coughing.
- Gastroesophageal reflux disease (GERD), which may cause hoarseness and a sensation of a lump in the throat.
- Precancerous lesions, such as leukoplakia.
- Malignant tumours.
- Vocal cord paralysis, caused by neurological conditions, surgery-related injuries or tumours affecting the laryngeal nerve.
- Presbyphonia, the age-related weakening and thinning of the vocal cords.
Conditions Not Visible on Examination
Hoarseness may also result from:
- Psychogenic conditions, including stress-related spasmodic dysphonia.
- Neuromuscular disorders, such as Parkinson's disease and myasthenia gravis.
- Hormonal disorders, particularly hypothyroidism.
When Is Hoarseness a Warning Sign?
Gkionis stresses that any hoarseness lasting longer than two to three weeks, particularly when accompanied by a constant need to clear the throat, should be evaluated by an ENT specialist.
The warning is especially important for:
- Smokers
- Heavy alcohol consumers
- People with persistent throat symptoms
Pain is not always present, meaning chronic hoarseness should not automatically be dismissed as a consequence of smoking or overuse of the voice.
Additional symptoms that require medical assessment include:
- Coughing up blood
- Shortness of breath
- A lump or swelling in the neck
- A persistent sensation of a lump or foreign body in the throat
- Ear pain that appears to originate from the throat
"Most cases of hoarseness are benign," he notes, "but assessment is necessary to rule out the possibility of malignancy, particularly in smokers."
How Is Hoarseness Investigated?
Assessment is typically straightforward and involves an examination by an ENT specialist.
Modern clinics commonly use high-definition endoscopes with cameras, enabling doctors to obtain detailed images of the vocal cords and larynx. Combined with clinical experience, these tools allow for highly accurate diagnosis and treatment planning.
If abnormalities such as polyps, nodules, cysts or tumours are detected, treatment may require surgery.
In milder cases, support from a speech and language therapist may be beneficial.
A common surgical procedure is microlaryngoscopy, performed under general anaesthesia using microscopes, advanced endoscopes, specialised microsurgical instruments and, where appropriate, laser technology.
The aim is to remove the lesion safely and precisely while preserving surrounding structures, promoting optimal healing and helping restore the voice as quickly as possible.
How to Protect Your Voice
Experts recommend:
- Avoiding excessive shouting and prolonged whispering, both of which can strain the vocal cords.
- Staying well hydrated.
- Maintaining adequate humidity indoors.
- Treating acid reflux when present.
- Quitting smoking.
- Following a healthy diet.
- Limiting alcohol, fizzy drinks and spicy foods.
Professional voice users — including teachers, singers, actors, lawyers and clergy — are also advised to undergo regular ENT check-ups.
