Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 May 8;112(19):329-37.
doi: 10.3238/arztebl.2015.0329.

Hoarseness-causes and treatments

Rudolf Reiter  1 , Thomas Karl Hoffmann, Anja Pickhard, Sibylle Brosch
Affiliations
Review

Hoarseness-causes and treatments

Rudolf Reiter et al. Dtsch Arztebl Int. .

Abstract

Background: Hoarseness (dysphonia) is the reason for about 1% of all consultations in primary care. It has many causes, ranging from self-limited laryngitis to malignant tumors of the vocal cords.

Methods: This review is based on literature retrieved by a selective search in PubMed employing the terms "hoarseness," "hoarse voice," and "dysphonia," on the relevant guideline of the American Academy of Otolaryngology -Head and Neck Surgery, and on Cochrane reviews.

Results: Hoarseness can be caused by acute (42.1%) and chronic laryngitis (9.7%), functional vocal disturbances (30%), and benign (10.7-31%) and malignant tumors (2.2-3%), as well as by neurogenic disturbances such as vocal cord paresis (2.8-8%), physiologic aging of the voice (2%), and psychogenic factors (2-2.2 %). Hoarseness is very rarely a manifestation of internal medical illness. The treatment of hoarseness has been studied in only a few randomized controlled trials, all of which were on a small scale. Voice therapy is often successful in the treatment of functional and organic vocal disturbances (level 1a evidence). Surgery on the vocal cords is indicated to treat tumors and inadequate vocal cord closure. The only entity causing hoarseness that can be treated pharmacologically is chronic laryngitis associated with gastro-esophageal reflux, which responds to treatment of the reflux disorder. The empirical treatment of hoarseness with antibiotics or corticosteroids is not recommended.

Conclusion: Voice therapy, vocal cord surgery, and drug therapy for appropriate groups of patients with hoarseness are well documented as effective by the available evidence. In patients with risk factors, especially smokers, hoarseness should be immediately evaluated by laryngos - copy.

PubMed Disclaimer

Figures

Figure 1a
Figure 1a
Indirect laryngoscopy during phonation
Figure 1b
Figure 1b
Indirect laryngoscopy during respiration
Figure 2
Figure 2
Algorithm for diagnosis of hoarseness. ENT, ear, nose, and throat; VCD, vocal cord dysfunction; PPI, proton pump inhibitor; EGD, esophagogastroduodenoscopy; VC, vocal cord
Figure 3
Figure 3
Laryngoscopy in a heavy smoker with chronic leukoplakia and bilateral sulcus vocalis. His voice sounded husky and strained
See this image and copyright information in PMC

Comment in

  • Hoarseness Caused by Glucocorticoids.
    Schoen HD. Schoen HD. Dtsch Arztebl Int. 2016 Feb 5;113(5):70. doi: 10.3238/arztebl.2016.0070a. Dtsch Arztebl Int. 2016. PMID: 26900157 Free PMC article. No abstract available.
  • Rule out Cancer Early.
    Thomas JP, Dazert S. Thomas JP, et al. Dtsch Arztebl Int. 2016 Feb 5;113(5):70. doi: 10.3238/arztebl.2016.0070b. Dtsch Arztebl Int. 2016. PMID: 26900158 Free PMC article. No abstract available.
  • In Reply.
    Reiter R. Reiter R. Dtsch Arztebl Int. 2016 Feb 5;113(5):70-1. doi: 10.3238/arztebl.2016.0070c. Dtsch Arztebl Int. 2016. PMID: 26900159 Free PMC article. No abstract available.

Similar articles

  • Update on Management of Hoarseness.
    Stinnett S, Chmielewska M, Akst LM. Stinnett S, et al. Med Clin North Am. 2018 Nov;102(6):1027-1040. doi: 10.1016/j.mcna.2018.06.005. Epub 2018 Sep 11. Med Clin North Am. 2018. PMID: 30342606 Review.
  • Clinical Practice Guideline: Hoarseness (Dysphonia) (Update).
    Stachler RJ, Francis DO, Schwartz SR, Damask CC, Digoy GP, Krouse HJ, McCoy SJ, Ouellette DR, Patel RR, Reavis CCW, Smith LJ, Smith M, Strode SW, Woo P, Nnacheta LC. Stachler RJ, et al. Otolaryngol Head Neck Surg. 2018 Mar;158(1_suppl):S1-S42. doi: 10.1177/0194599817751030. Otolaryngol Head Neck Surg. 2018. PMID: 29494321
  • Hoarseness in Adults.
    House SA, Fisher EL. House SA, et al. Am Fam Physician. 2017 Dec 1;96(11):720-728. Am Fam Physician. 2017. PMID: 29431404
  • Clinical practice guideline: hoarseness (dysphonia).
    Schwartz SR, Cohen SM, Dailey SH, Rosenfeld RM, Deutsch ES, Gillespie MB, Granieri E, Hapner ER, Kimball CE, Krouse HJ, McMurray JS, Medina S, O'Brien K, Ouellette DR, Messinger-Rapport BJ, Stachler RJ, Strode S, Thompson DM, Stemple JC, Willging JP, Cowley T, McCoy S, Bernad PG, Patel MM. Schwartz SR, et al. Otolaryngol Head Neck Surg. 2009 Sep;141(3 Suppl 2):S1-S31. doi: 10.1016/j.otohns.2009.06.744. Otolaryngol Head Neck Surg. 2009. PMID: 19729111
  • Hoarseness: When to observe and when to refer.
    Ferraro EL, Nelson RC, Bryson PC. Ferraro EL, et al. Cleve Clin J Med. 2023 Aug 1;90(8):475-481. doi: 10.3949/ccjm.90a.23010. Cleve Clin J Med. 2023. PMID: 37527869 Review.
See all similar articles

Cited by

See all "Cited by" articles

References

    1. Cohen SM, Kim J, Roy N, Asche C, Courey M. Prevalence and causes of dysphonia in a large treatment—seeking population. Laryngoscope. 2012;122:343–348. - PubMed
    1. Schwartz SR, Cohen SM, Dailey SH, et al. Clinical practice guideline: hoarseness (dysphonia) Otolaryngol Head Neck Surg. 2009;141:1–31. - PubMed
    1. Bos-Clark M, Carding P. Effectiveness of voice therapy in functional dysphonia: where are we now? Curr Opin Otolaryngol Head Neck Surg. 2011;19:160–164. - PubMed
    1. Dworkin JP. Laryngitis: Types, causes and treatments. Otolaryngol Clin North Am. 2008;41:419–436. - PubMed
    1. Reveiz L, Cardona AF. Antibiotics for acute laryngitis in adults. Cochrane Database Syst Rev. 2013;3 CD004783. - PubMed