If you’ve ever cheered a team to victory or had a cold, you’ve probably had experience with vocal changes, hoarseness, or even laryngitis. A temporary change in voice is normal in these instances. But if you ever have a change in voice that lasts for more than two weeks, it’s time for a trip to the doctor.
The Anatomy of Talking
When we speak, air passes through the larynx, or voice box in our throat. Inside the larynx there are two vocal cords or folds which are bands of smooth muscle that lie opposite each other. When we breathe, these vocal folds open to allow air to pass through. When we vocalize, the folds come together, and vibrate when air passes between them. The sound from this vibration travels through the throat, nose, and mouth to produce speech or singing.
Disorders of the Voice
Voice disorders occur when something goes wrong with the vocal folds. This could be laryngitis  or hoarseness caused by a viral or bacterial infection—conditions that will typically clear up within two weeks. People who use their voices excessively, such as singers, cheerleaders, teachers, and lawyers, may also suffer from long term hoarseness as a result of vocal abuse or misuse.
The National Institute of Health lists these as the most common disorders resulting from vocal abuse:
- Laryngitis: inflammation or swelling of the vocal folds. The voice of someone with laryngitis will often sound raspy, breathy, and hoarse.
- Vocal nodules: small, non-cancerous growths on the vocal cords. Nodules typically form in pairs at the point where the vocal cords come together, much like a callous forms on the feet where there is pressure from shoes. Vocal nodules are the most common voice disorder directly related to vocal abuse. The voice of a person with nodules usually sounds hoarse, low-pitched, and slightly breathy.
- Vocal polyps: non-cancerous growths that are softer than vocal nodules, more like a blister than a callous. Vocal polyps typically form on only one vocal cord and are often associated with long-term cigarette smoking or hypothyroidism (decreased thyroid activity). The voice of a person with vocal polyps typically sounds hoarse, low-pitched, and slightly breathy, much like a person with vocal nodules.
- Contact ulcers: ulcerated sores or places where the tissue on or near the larynx or voice box is worn away. Contact ulcers are usually caused by excessive force when speaking, or by gastroesophageal reflux (acid from the stomach that rises up the esophagus). People with contact ulcers often feel pain in the throat, especially while talking, and complain that their voices tire easily.
Two Weeks Is Too Long
While some of these conditions may resolve themselves with time, it’s important to have a doctor’s examination if hoarseness lasts more than two weeks. Persistent hoarseness can be a symptom of cancer of the larynx. A visit to the doctor is especially important for patients who smoke.
Otolaryngologists are doctors who specialize in diseases of the ears, nose, throat, head and neck. Using a tiny mirror, or a fiber-optic camera, the Otolaryngologist can look directly at the vocal cords to see the cause of the problem. In some cases, treatment may include vocal rest and training in good vocal techniques. In other instances, an operation may be necessary to remove growths from the vocal cords. In many cases, surgery is followed by voice therapy by a speech-language pathologist to help retrain the behavior and keep the vocal abuse from recurring. Vocal training can also help children learn proper voice behaviors to limit vocal abuse and prevent repeated hoarseness.
The bottom line—check with your doctor if your hoarseness won’t go away.