What causes hoarseness of voice after speaking?

From the Guidelines

A hoarse voice after talking is typically caused by vocal strain or laryngitis, and the most effective treatment is to rest your voice, stay hydrated, and avoid irritants, as recommended by the most recent clinical practice guideline on hoarseness (dysphonia) 1. To manage this condition, it is essential to:

• Rest your voice as much as possible for 1-2 days
• Avoid whispering, which can strain your voice more
• Drink plenty of water, at least 8 glasses daily, to keep your vocal cords hydrated
• Use a humidifier, especially while sleeping, to maintain moisture in your throat
• Avoid irritants like smoking, alcohol, caffeine, and spicy foods that can worsen inflammation
• Try gargling with warm salt water (1/4 teaspoon salt in 8 ounces of water) several times daily for immediate relief The purpose of this approach is to promote awareness of dysphonia as a condition that may decrease a patient's quality of life or be a harbinger of a serious underlying condition, as stated in the clinical practice guideline 1. It is also crucial to be aware of the factors that modify management, such as recent surgical procedures, radiation treatment, or occupation as a singer or vocal performer, as highlighted in the clinical practice guideline 1. Additionally, preventive measures, such as adequate hydration, avoidance of irritants, voice training, and amplification, may reduce the risk of developing dysphonia, as suggested by the clinical practice guideline 1. If your hoarseness persists beyond two weeks, is accompanied by pain, difficulty swallowing, or blood in your saliva, or if you rely on your voice professionally, you should see a doctor, as persistent hoarseness may indicate more serious conditions that require medical attention 1.

From the Research

Causes of Hoarse Voice

• Hoarseness can be caused by acute (42.1%) and chronic laryngitis (9.7%), functional vocal disturbances (30%), and benign (10.7-31%) and malignant tumors (2.2-3%) 2
• Other causes of hoarseness include neurogenic disturbances such as vocal cord paresis (2.8-8%), physiologic aging of the voice (2%), and psychogenic factors (2-2.2 %) 2
• Vocal cord dysfunction can also lead to hoarseness, particularly in cases where there is abnormal laryngeal muscle spasms (vocal cord closure is less severe) 3

Treatment of Hoarse Voice

• Voice therapy is often successful in the treatment of functional and organic vocal disturbances (level 1a evidence) 2
• Surgery on the vocal cords is indicated to treat tumors and inadequate vocal cord closure 2
• The only entity causing hoarseness that can be treated pharmacologically is chronic laryngitis associated with gastro-esophageal reflux, which responds to treatment of the reflux disorder 2
• Therapeutic breathing maneuvers and vocal cord relaxation techniques are first-line therapy for dyspnea that occurs with vocal cord dysfunction 3
• OnabotulinumtoxinA injections may be helpful for spasmodic dysphonia and for treating dyspnea in certain cases, although evidence is limited 3
• Glottic airway and respiratory retraining, botulinum toxin injections, low-dose amitriptyline and inspiratory muscle strength training devices have been associated with symptom reduction in adults and adolescents with vocal cord dysfunction 4

Diagnosis of Hoarse Voice

• Fiberoptic laryngoscopy is the diagnostic gold standard to demonstrate paradoxical vocal cord adduction during an attack of vocal cord dysfunction 5
• Nasolaryngoscopy and pulmonary function testing, with provocative exercise and methacholine, can help diagnose vocal cord dysfunction and are helpful to evaluate for other etiologies 3
• Laryngoscopy should be immediately performed in patients with risk factors, especially smokers, to evaluate hoarseness 2