From the Guidelines
Chronic hoarseness is most commonly caused by vocal cord nodules, polypoid vocal fold lesions, and vocal fold atrophy, which can result from voice overuse, intubation, or neurologic disorders, and can significantly impact quality of life, particularly in older adults and young children. The causes of chronic hoarseness can be multifactorial, including:
- Vocal cord nodules or polyps from voice overuse, which can occur in individuals who depend heavily on their voice, such as teachers and clergy, as seen in over 50 percent of teachers who experience hoarseness 1
- Vocal fold atrophy, which is a common disorder in older adults and can result in hoarseness, often going undiagnosed by primary care providers 1
- Neurologic disorders, such as cerebral vascular accident, Parkinson disease, and multiple sclerosis, which can lead to hoarseness in patients of any age 1
- Intubation, which can cause prolonged true vocal fold immobility, chronic phonatory dysfunction, and vocal fold granuloma, resulting in hoarseness that may persist after extubation 1
- Environmental factors, such as smoke, dust, and chemical fumes, which can irritate the vocal cords and contribute to chronic hoarseness
- Medications, such as inhaled corticosteroids, which can cause hoarseness as a side effect of therapy, either from direct irritation or from a fungal infection of the larynx 1 It is essential to evaluate the underlying cause of chronic hoarseness, as treatment depends on the specific condition, and early diagnosis can improve treatment outcomes for serious conditions, such as laryngeal cancer, particularly in smokers 1.
From the Research
Causes of Chronic Hoarseness
- Chronic hoarseness can be caused by a variety of factors, including inflammatory processes, psychiatric disorders, systemic, neurologic, or cancerous conditions 2
- Medication-induced hoarseness is also a common cause and should be considered in the evaluation of hoarseness 2
- Other causes of hoarseness include:
- Neurological disorders, such as Parkinson's disease, can also cause hoarseness due to abnormalities in vocal cord function and laryngeal muscle rigidity or bradykinesia 4, 5
- Vocal cord nodules, also known as laryngeal nodules or singer's nodes, can also cause chronic hoarseness 6
Risk Factors
- Tobacco use and heavy alcohol use are risk factors for dysplasia and may require earlier laryngoscopic evaluation 2
- Hemoptysis is also a risk factor for dysplasia and may require earlier laryngoscopic evaluation 2
- Patients with Parkinson's disease may be at higher risk for hoarseness due to laryngeal abnormalities and vocal cord dysfunction 4, 5