Hoarseness, or dysphonia, is an abnormal change in the quality of the voice that makes it sound rough, raspy, breathy, or strained. It occurs when the vocal cords in the larynx do not vibrate normally. While short-term hoarseness after a cold is common, persistent hoarseness lasting more than three weeks should be assessed by an ENT specialist to identify the cause and rule out serious conditions.
Hoarseness can present in several ways depending on the underlying cause:
Benign vocal cord lesions: Nodules, polyps, and cysts are common causes of persistent hoarseness, particularly in people who use their voice heavily such as teachers, singers, and call centre workers.
Laryngitis: Acute laryngitis from a viral infection is the most common cause of short-term hoarseness. Chronic laryngitis may be caused by reflux, smoking, or inhaled irritants.
Laryngopharyngeal reflux (LPR): Stomach acid reaching the larynx can cause inflammation and swelling of the vocal cords, leading to chronic hoarseness, throat clearing, and a sensation of a lump in the throat.
Vocal cord paralysis: Damage to the nerves controlling the vocal cords can result from thyroid or neck surgery, viral infection, or neurological conditions. It causes a breathy, weak voice.
Laryngeal cancer: Persistent hoarseness in a smoker or heavy drinker must be investigated to rule out laryngeal cancer. Early detection offers excellent treatment outcomes.
At Central Sydney ENT, the assessment of hoarseness begins with a detailed history covering the onset, duration, voice demands, smoking history, and associated symptoms such as swallowing difficulty or weight loss.
The key diagnostic tool is flexible nasendoscopy, where a thin camera is passed through the nose to directly visualise the vocal cords. This painless examination takes a few minutes and shows the structure and movement of the cords. In some cases, videostroboscopy is performed to assess vocal cord vibration patterns in detail.
If a suspicious lesion is identified, a microlaryngoscopy under general anaesthetic may be recommended to obtain a biopsy and a definitive diagnosis.
Speech pathology is the first-line treatment for many functional voice disorders and vocal cord nodules. We work closely with speech pathology colleagues to provide targeted voice rehabilitation.
Reflux-related hoarseness is managed with proton pump inhibitors and lifestyle modifications including dietary changes, avoiding late meals, and elevating the head of the bed.
Microlaryngoscopy is performed under general anaesthetic to remove vocal cord polyps, cysts, or other lesions. Vocal cord injection (medialisation) can restore voice in cases of vocal cord paralysis. Laryngeal framework surgery (thyroplasty) is an option for permanent vocal cord paralysis.
Seek specialist assessment if your hoarseness lasts more than three weeks, occurs without an upper respiratory infection, is accompanied by difficulty swallowing or breathing, or if you are a smoker with any voice change. A simple clinic examination can quickly identify the cause and guide treatment.
Central Sydney ENT has six FRACS-qualified ENT surgeons and an on-site speech pathologist across seven Sydney locations in Burwood, Campbelltown, Gregory Hills, Ultimo, Drummoyne, Hunters Hill, and Miranda.
Voice disorders are managed by our surgeons with support from our on-site speech pathologist:
Ask your GP for a referral to Central Sydney ENT, or call our reception team directly.