Hoarseness: causes and home remedies

Brief overview

  • Description: Rough, husky voice with reduced volume. Hoarseness can be acute or chronic.
  • Causes: e.g. vocal overload or misuse, colds, vocal cord nodules or paralysis, tumors on the vocal cords, nerve damage, pseudocroup, diphtheria, acute bronchitis, chronic bronchitis, COPD, tuberculosis, reflux disease, allergies, stress, medication
  • Home remedies: Depending on the trigger, it can help not to eat too hot or spicy food, drink warm drinks, suck on lozenges, apply warm throat compresses to the throat, ensure high humidity; essential oils can also be used.
  • When to see a doctor: for hoarseness that lasts more than three weeks or recurs, for acute hoarseness without cold symptoms and with a feeling of tightness or shortness of breath, for children if the hoarseness is accompanied by a barking cough.
  • Examinations: including patient interview, physical examination, pharyngoscopy/swab, laryngoscopy, tissue sampling, blood test, lung function test, gastroscopy, computer tomography (CT)
  • Therapy: depending on the cause, e.g. with medication, speech therapy or surgery.

Hoarseness Description

Brief overview

  • Description: Rough, husky voice with reduced volume. Hoarseness can be acute or chronic.
  • Causes: e.g. vocal overload or misuse, colds, vocal cord nodules or paralysis, tumors on the vocal cords, nerve damage, pseudocroup, diphtheria, acute bronchitis, chronic bronchitis, COPD, tuberculosis, reflux disease, allergies, stress, medication

Home remedies: Depending on the trigger, it can help not to eat too hot or spicy food, drink warm drinks, suck on lozenges, apply warm throat compresses to the throat, ensure high humidity; essential oils can also be used.

When to see a doctor: for hoarseness that lasts more than three weeks or recurs, for acute hoarseness without cold symptoms and with a feeling of tightness or shortness of breath, for children if the hoarseness is accompanied by a barking cough.

Examinations: including patient interview, physical examination, pharyngoscopy/swab, laryngoscopy, tissue sampling, blood test, lung function test, gastroscopy, computer tomography (CT)

    Therapy: depending on the cause, e.g. with medication, speech therapy or surgery.

  • Hoarseness Description
  • Laryngitis: Acute laryngitis often accompanies a cold. It causes acute hoarseness (sometimes leading to loss of voice), the urge to clear the throat, coughing, burning and scratching in the throat and possibly fever. Chronic laryngitis can be caused by smoking, frequent inhalation of dust or dry air, chronic vocal overload, alcohol addiction or vocal fold nodules, for example. Sometimes it is also a side effect of medication such as antidepressants.
  • Vocal fold polyps: Polyps on the vocal folds are benign changes to the mucous membrane. They usually form after an acute laryngitis if the patient has not kept to the vocal rest recommended by the doctor. The hoarseness then persists even after the laryngitis has subsided. Incidentally, smoking favors such polyps.
  • Vocal cord paralysis (recurrent paresis): Vocal cord paralysis (vocal fold paralysis) is often unilateral and is accompanied by hoarseness. It is triggered by damage to the nerve that is important for the function of the vocal apparatus (recurrent nerve). For example, the nerve can be injured during thyroid surgery (or other operations in the throat area) or constricted by space-occupying processes (such as laryngeal tumors, sarcoidosis, aortic aneurysms). In addition, viral infections (such as influenza, herpes infection), toxins (such as alcohol, lead), rheumatic diseases and diabetes can also result in nerve damage with vocal cord paralysis and hoarseness. Sometimes the cause of the paralysis remains unexplained.
  • Pseudocroup: In the context of laryngitis, the laryngeal outlet can swell up considerably, especially in infants and small children. As a result, acute hoarseness, a barking cough and shortness of breath occur. Doctors refer to this as pseudocroup or croupy cough. In the event of severe coughing fits with shortness of breath, call an emergency doctor immediately!
  • Diphtheria (true croup): This highly contagious infectious disease is caused by bacteria. The pathogens primarily trigger inflammation in the nasopharynx. This pharyngeal diphtheria can develop into laryngeal diphtheria with the symptoms of hoarseness, loss of voice and a barking cough. In addition, breathing problems can progress to the point of suffocation.
  • Acute bronchitis: Acute bronchitis is an inflammatory respiratory infection caused by viruses or (more rarely) bacteria. It is very common and causes hoarseness, fever, cough, pain behind the sternum, headache, muscle aches and aching limbs.
  • Chronic bronchitis: In chronic bronchitis, the bronchial tubes are not only temporarily inflamed (as in acute bronchitis), but permanently inflamed. It mainly affects men, primarily smokers and ex-smokers. In addition to hoarseness, chronic bronchitis is mainly characterized by a chronic cough with thick sputum.
  • COPD: Chronic bronchitis can lead to a narrowing (obstruction) of the bronchial tubes over time. If this chronic obstructive bronchitis is accompanied by lung inflation (emphysema), doctors speak of COPD. Those affected mainly suffer from a chronic cough, sputum production and shortness of breath. Hoarseness can also occur.
  • Underactive thyroid gland (hypothyroidism): An underactive thyroid can also be associated with hoarseness. Other symptoms include weight gain, fatigue, dry and flaky skin, dry and brittle hair, constipation and goitre. Hypothyroidism can be congenital or acquired.
  • Tuberculosis (consumption): Tuberculosis (TB) is a chronic bacterial infectious disease that can affect the larynx (laryngeal tuberculosis) – either this alone or in addition to the lungs (pulmonary tuberculosis). The main symptoms of laryngeal tuberculosis are hoarseness and difficulty swallowing. Coughing and weight loss are also common.
  • Reflux disease: Reflux disease (gastroesophageal reflux) is defined by doctors as the reflux of acidic stomach contents into the oesophagus. In addition to typical symptoms such as heartburn, reflux disease can also cause hoarseness.
  • Laryngeal cancer (laryngeal carcinoma): Laryngeal cancer mainly affects heavy smokers, especially if they consume a lot of alcohol at the same time. The symptoms of this malignant tumor include persistent hoarseness with difficulty swallowing, a foreign body sensation and coughing up blood.
  • Psychological stress: Sometimes acute or chronic psychological stress triggers hoarseness. Anxiety, excitement, depression and heartache can be to blame if the voice is suddenly gone.
  • General weakness: People who are generally weakened due to old age or a serious illness often have a hoarse, weak voice.
  • Injury to the larynx: External injuries such as bruising or choking can result in acute hoarseness; sometimes the voice is also temporarily lost.
  • Side effect of medication: Cortisone sprays, such as those often used by asthma patients, can cause hoarseness as a side effect, as well as fungal infestation of the oral mucosa (oral thrush). Other medications such as allergy remedies (antihistamines) and depressants (antidepressants), diuretics and female sex hormones (oestrogens, for example in hormonal contraceptives) can also cause hoarseness.

What helps against hoarseness

Treatment will vary depending on how severe the hoarseness is, how long it has been going on and how likely it is to be caused by a serious illness.

How the doctor can treat hoarseness

Home remedies for hoarseness

  • Take it easy: If you suffer from hoarseness due to overstraining your voice, the first thing to do is to take it easy. So talk as little as possible!
  • Speak out loud: Many people start whispering when they are hoarse, but this only strains the vocal cords. On the other hand, half-loud speech is permitted.
  • Keep to a “diet”: If acute or chronic laryngitis is to blame for the hoarseness, you should follow the “larynx diet”: Don’t eat food that is too hot or too spicy. Avoid cold foods (such as ice cream) and drinks. Don’t smoke and don’t talk too much (protect your voice!). These tips will also help if the hoarseness has causes other than laryngitis (such as pharyngitis or vocal fold nodules).
  • Warm drinks: Drink plenty of warm drinks if you have hoarseness. For acute laryngitis, for example, a tea mixture of 50 g fern frond herb (Herba Adiantis capillis veneris), 20 g mallow leaves (Folium Malvae sylvestris) and 30 g thyme herb (Herba Thymi vulgaris) is recommended. Drink five cups of this tea daily.
  • Ribwort plantain tea: Ribwort plantain tea can also relieve hoarseness: Pour 250 ml of hot water over two teaspoons of the tea drug, leave to infuse for 15 minutes. Drink a cup twice a day. You can also gargle with the tea.
  • Inhalation: Chamomile, fennel and peppermint tea are effective for pharyngitis, which is often accompanied by hoarseness. Inhale the vapors of the hot tea before drinking it.
  • High humidity: If you have hoarseness, make sure the humidity in the room is high enough. The inhalation mentioned above is also good for the throat and vocal cords – either just with hot water or add some salt or medicinal herbs (camomile, fennel, etc.) to the water.
  • Fennel milk: Fennel milk is also a popular remedy for hoarseness caused by pharyngitis: Boil 3 teaspoons of fennel seeds with half a liter of milk; then strain and sweeten the milk with honey.
  • Suck yourself healthy: Adults and older children suffering from hoarseness and sore throats can reach for lozenges containing sage or Icelandic moss.
  • Throat compresses: If you suffer from hoarseness due to a cold, pharyngitis or other throat infections, you should keep the throat area evenly warm: Wrap a scarf around your neck and/or make yourself a throat compress for sore throats, for example a warm potato compress: boil the potatoes, mash them, wrap them in a cloth and place them on your neck (check the temperature!). Keep the compress on your neck until it has cooled down.
  • Essential oils: Aromatherapy uses essential oils such as eucalyptus, spruce needle, marjoram, rosemary and thyme oil to treat cold symptoms such as hoarseness, coughs and colds – either for rubbing in or inhaling.

Before using essential oils on children, you should consult a therapist or doctor. This is because some essential oils such as eucalyptus oil, mint oil or camphor can cause cramping of the respiratory muscles in small children, with the risk of suffocation!

Home remedies have their limits. If the symptoms persist over a longer period of time and do not improve or even get worse, you should always consult a doctor.

Homeopathy for hoarseness

Many patients try homeopathic remedies (e.g. globules) for hoarseness. These include Ferrum phosphoricum C30 (laryngitis and dry hoarseness), Carbo vegetabilis C30 (hoarseness in the evening), Causticum D12 and Spongia D6 (for hoarseness caused by overstraining the vocal cords).

Patients with hoarseness, dry cough, sore throat and fever with chills are often advised to take Drosera. A homeopath can provide information on dosage and frequency of administration.

The concept of homeopathy and its specific effectiveness are controversial and have not been clearly proven by studies.

Hoarseness: When do you need to see a doctor?

  • Hoarseness that lasts longer than three weeks – especially if you have no suspicion of a possible cause (suspected laryngeal cancer!)
  • Recurrent hoarseness, especially with prolonged vocal strain
  • Acute hoarseness or even loss of voice if there are no cold symptoms but an increasing feeling of tightness or shortness of breath
  • Acute hoarseness and barking cough in children

In contrast, there is usually no need to worry about hoarseness in male adolescents: A raspy, husky voice at the beginning of voice breakage is normal.

Hoarseness: What does the doctor do?

To find out what has caused the hoarseness, the doctor will first ask you in detail about your medical history (anamnesis). Important information includes, for example

  • How long has the hoarseness been present?
  • Are there any accompanying symptoms such as difficulty clearing your throat, coughing, shortness of breath or fever?
  • Do you smoke?
  • Do you drink alcohol frequently?
  • Do you have any chronic illnesses such as asthma?
  • Are you taking any medication?
  • What is your profession (e.g. a vocally demanding profession such as teacher, opera singer)?

Important examinations for hoarseness

From this information, the doctor will usually already have an idea of what could have caused the hoarseness. Further examinations can confirm the suspicion:

Pharyngoscopy (pharyngoscopy): The doctor examines the throat using a small mirror or special endoscope (a tube-shaped medical instrument) if he suspects an inflammation of the throat as the cause of hoarseness, for example.

Throat swab: If the acute bacterial infectious disease diphtheria is a possible cause of hoarseness, the doctor will take a throat swab with a spatula to take a bacterial culture. If diphtheria bacteria can actually be cultivated from the swab, this confirms the doctor’s suspicion.

Laryngoscopy (laryngoscopy): An endoscopic examination of the larynx is performed if, for example, laryngitis, epiglottitis or laryngeal cancer is suspected as the cause of hoarseness.

Biopsy: As part of the laryngoscopy, the doctor can also take a tissue sample (biopsy) if he discovers suspicious cell growths (tumors) on the vocal cords or larynx, for example.

Examination of the sputum (sputum examination): The patient’s sputum is analyzed with regard to color, odor, consistency, composition, etc. if the doctor suspects acute bronchitis as the cause of hoarseness.

X-ray examination: An X-ray examination is used to clarify asthma, chronic bronchitis, COPD and tuberculosis as possible causes of hoarseness.

Lung function test: A lung function test using spirometry reveals whether bronchial asthma may be causing the hoarseness.

Gastroscopy (oesophago-gastroscopy): A look with an endoscope into the oesophagus and stomach shows whether a reflux of acidic stomach contents into the oesophagus (reflux disease) is behind the hoarseness.

Ultrasound examination (sonography): In the ultrasound image, the doctor can identify an enlarged thyroid gland (goitre) as the cause of hoarseness.

Computed tomography (CT): A CT scan is used to clarify tumors (such as laryngeal cancer) as possible causes of hoarseness. CT is also used in cases of suspected vocal cord paralysis.