What is the treatment for a hoarse voice?

Treatment for Hoarse Voice

Voice therapy should be the first-line treatment for hoarseness (dysphonia), combined with preventive measures and lifestyle modifications to improve vocal health. 1

Initial Management Approach

• Voice therapy is effective for hoarseness across all age groups and should be considered the primary initial treatment, typically consisting of 1-2 therapy sessions weekly for 4-8 weeks 1
• Voice therapy aims to eliminate harmful vocal behaviors, shape healthy vocal behavior, and assist in vocal fold wound healing 1
• Certified and licensed speech-language pathologists are the healthcare professionals with expertise needed to provide effective behavioral treatment for hoarseness 1

Preventive Measures and Vocal Hygiene

Things to DO:

• Maintain adequate hydration by drinking water daily (absence of water intake is associated with 60% higher risk of dysphonia) 1
• Use amplification in large noisy spaces to reduce voice strain 1
• Rest your voice briefly to prevent voice fatigue, straining, and overuse 1
• Provide indoor air humidification in dry environments 1
• Engage in regular physical exercise (≥3 times a week), which has been associated with lower prevalence of dysphonia 1

Things to AVOID:

• Smoking and secondhand smoke exposure that can irritate the airway 1
• Overusing or straining your voice through yelling, shouting, speaking over loud noises, and whispering 1
• Excessive throat clearing and coughing 1
• Alcohol and caffeine consumption that can dry the throat 1
• Use of drying medications 1

Specialized Treatments Based on Underlying Cause

For Spasmodic Dysphonia:

• Botulinum toxin injections are considered the "treatment of choice" for adductor spasmodic dysphonia 1
• Multiple double-blind, randomized, placebo-controlled trials have shown improved voice quality and voice-related quality of life with botulinum toxin treatment 1
• Treatment effects typically last 3-6 months and can be performed on awake, ambulatory patients with minimal discomfort 1

For Vocal Fold Paralysis:

• Voice therapy is the first-line treatment, which can be used alone or as part of a comprehensive approach 2
• For persistent paralysis, injection laryngoplasty or framework procedures may be considered depending on severity and duration 2
• Early injection (within 6 months of onset) has been shown to decrease the need for more invasive long-term therapy 2

For Benign Vocal Fold Lesions:

• Voice therapy is the first-line treatment for vocal fold lesions like nodules, polyps, or cysts 1
• Surgery should only be considered for symptomatic benign vocal fold lesions not responding to conservative management 3
• Both CO₂ laser and microdissection are acceptable modalities for surgical resection when necessary 4

Follow-up and Monitoring

• Clinicians should document resolution, improvement, or worsened symptoms of dysphonia after treatment or observation 1
• If hoarseness persists beyond 4 weeks despite appropriate treatment, laryngoscopy should be performed to rule out serious underlying conditions 3, 5
• Patients with risk factors (especially smokers) should have immediate laryngoscopic evaluation if hoarseness develops 6

Special Considerations

• Professional voice users (teachers, singers, attorneys, public speakers) may require more urgent evaluation and treatment due to occupational impact 3, 5
• Empirical treatment of hoarseness with antibiotics or corticosteroids is not recommended without a specific indication 6, 5
• Despite widespread use, proton pump inhibitors for treating laryngopharyngeal reflux have been shown in high-quality studies to be no more effective than placebo 4