When Do I Get Checked for Hoarseness (or Cough)

coughing fits or lingering cough

Hoarseness is a state in voice changes that include breathiness, raspy or strained voice. It may also be associated with a soft low pitch voice and a scratchy throat. In most cases, this disorder arises from problems with the larynx. Occasional voice hoarseness can occur due to various causes, but when it persists for more than 3 weeks in the absence of an upper respiratory infection, it should be evaluated by an ENT specialist.

Common causes of hoarseness include

These include:

  • Inflammation of the larynx
  • Overuse and misuse of your voice. This can occur due to repeated shouting events (compare cheering favorite teams and some preachers)
  • This is also known as gastroesophageal reflux disorder (GERD)
  • Growths on the vocal cords
  • Smoking
  • Bleeding on the vocal cords
  • Neurological disorders. For example the injury of the common laryngeal nerve during thyroidectomy and other neck or throat surgical procedures.
  • Some types of throat cancer

When does hoarseness require evaluation?

According to the American Academy of Otolaryngology – Head and Neck Surgery, hoarseness evaluation should be considered when one or a combination of the following factors is present.

  1. The hoarseness is more than 3 weeks
  2. There is no associated cold or flu
  3. There is difficulty in swallowing
  4. There is throat pain when you speak
  5. There is a palpable mass on the neck
  6. If you have been using your voice to earn a living but you are now unable to
  7. If there is sudden loss of voice that persists for even a few days
  8. There is accompanying difficulty in breathing
  9. If you cough up blood
  10. If there are other symptoms such as loss of weight, fever, night sweats, and other constitutional signs and symptoms.

How a hoarseness evaluation is carried out

At Advanced Ear Nose and Throat Associates we carry out a detailed assessment of the patient who presents with hoarseness. This includes the following.


We dig deep into the history of how the hoarseness started. This will include an attempt to unveil any risk factors or specific cause(s) leading to the condition. Aspects of a useful history of the illness include:

  • Patients past medical and surgical history
  • Occupation
  • Social history
  • Lifestyle and habits such as smoking


A thorough general examination is done to rule out or confirm any associated (or independent) health issues. Specific examination is carried out on the ENT system. These include:

  • Throat visualization using a mirror
  • Visual examination of the vocal cords with the help of a special equipment called a laryngoscope.
  • Use of a fiberoptic scope. This employs the use of a flexible tube inserted through the nose. It has a lighted end and a special camera that will pick most visible disorders in the throat. It is useful in identifying throat muscles problems, growths, and any swelling.
  • More advanced visualization can be done with a video-stroboscope to get a slow-motion view of the vocal cords vibrating to look for subtle vibratory problems.

Fiberoptic throat evaluation is a painless procedure that is well-tolerated by many patients. It is a quick and safe office procedure that offers immediate results. This is good for your peace of mind because it helps you to get the right treatment for the identified problem.

How to reduce risk of voice hoarseness

  • Avoid smoking and secondhand smoke
  • Keep your body well-hydrated
  • Use your voice responsibly
  • Minimize the use of spiced foods
  • Use a room humidifier
  • Do not over use your voice when you are sick – speaking or whispering excessively while you already have hoarseness will make it worse!





National Institute on Deafness and Other Communication Disorders (NIDCD)

National Academy of Otolaryngology – Head and Neck Surgery