Acute and Chronic Hoarseness

Hoarseness can refer to any changes in the voice resulting in a breathy, rough, raspy or strained quality with differences in vocal projection or pitch. These changes can be either acute or chronic and are due to conditions including laryngitis or inflammation of the vocal folds, laryngopharyngeal reflux (LPR, acid reflux), vocal overuse, muscle tension and vocal fold masses (polyps, cysts, nodules). Most treatment is conservative and involves medication, speech and/or singing voice therapy and temporary modifications in voice use. Although in some severe circumstances, surgery may be required.

Acute and Chronic Hoarseness

Flexible Laryngoscopy

Diagnosing problems with the voice and throat often requires looking into the deep throat and voice box, beyond what can be seen through a mouth examination. Flexible laryngoscopy uses a fiber optic scope to examine the throat and larynx.

The procedure can examine the source of problems with the voice, swallowing, other throat pain and even some conditions related to the ears. The scope enters through the nose and down the back of the throat, typically under local anesthetic. The patient may be asked to speak, cough, or otherwise use their throat and larynx during the exam, which usually lasts about 5 minutes. The nose and throat may feel irritated for a day or two.

Speech Therapy

For people who make their living using their voice, such as public speakers, entertainers, television and radio personnel, or teachers, constant use may cause hoarseness or other throat and voice issues. Problems that frequently arise from improper use of the voice include discomfort or pain, vocal strain, and voice fatigue.

Complications include vocal nodes, cysts, swollen or bleeding vocal cords, and paralysis of the vocal cords. Speech therapy introduces exercises and practices to relieve the strain on the voice and rehabilitate vocal abuse behaviors, and may also include diet and lifestyle changes when reflux contributes to throat and vocal cord irritation.


Examination of problems with the larynx and vocal cords often requires a detailed analysis of how the vocal cords themselves move. Since they vibrate at high speed, videostroboscopy exams simulation slow motion movement of the vocal cords.

The procedure may be done with a rigid endoscope through the mouth or a flexible endoscope through the nose and rear of the throat. The patient produces sounds of various pitch and volume while a video recording tracks the activity of the vocal cords. This permits detailed viewing of the vocal cord vibrations for purposes of diagnosis.

Surgery (Microflap, Biopsy, Laser Treatment)

In some cases, vocal hoarseness may be persistent, necessitating surgical correction to speed recovery. Microflap surgery typically addresses benign lesions, such as nodes, polyps, or cysts, that do not respond to more conservative forms of management. Left untreated, these may develop into more progressive scarring of the vocal cord tissue.

The microflap surgical technique cuts these lesions out of the vocal cords, resulting in less scarring and a loss of hoarseness. Biopsies take small samples of tissue to diagnose cancer of the larynx, often revealed through vocal hoarseness as a symptom. Surgical CO2 laser surgery has proven effective as a treatment for both benign and malignant vocal cord lesions.