A hoarse voice after a cold, after a night of a great deal of talking or after a concert is something most of us have experienced. In the majority of cases the cause is laryngitis — inflammation of the larynx, that is, the part of the throat where the vocal cords are located. When the tissue around the vocal cords swells, the voice changes: it becomes hoarse, deeper, or disappears temporarily.
In this article we explain the most common causes of laryngitis, how the acute form differs from the chronic one, how long it usually lasts, how it is treated and — most importantly — when hoarseness should not be left without an assessment by an ENT (otorhinolaryngology) specialist.
What is laryngitis?
The larynx is the organ located in the front of the neck, between the throat and the trachea (the windpipe). Inside it are two vocal cords — two folds of tissue that vibrate as air passes over them, producing the voice. For the voice to sound clear, the cords must be smooth, moist and move symmetrically.
When the lining of the larynx becomes inflamed, the vocal cords swell and no longer vibrate in the same way. The result is dysphonia — a change in voice quality, which in everyday language we call hoarseness.
Acute and chronic laryngitis
- Acute laryngitis — appears quickly, usually after a viral infection of the upper airways or after overusing the voice. It resolves within a few days to two weeks.
- Chronic laryngitis — symptoms last longer than three weeks or keep returning. It is usually not caused by an infection, but by an irritating factor acting over a long period, such as smoking, reflux or continuous professional use of the voice.
The most common causes
Viral infections
The most common cause of acute laryngitis are the viruses of the common cold and influenza. In these cases laryngitis is accompanied by a runny nose, cough, a mild temperature and a sore throat.
Voice overuse
Shouting, singing without technique, teaching in a loud voice or speaking for long periods in noisy environments tire the muscles and the tissue of the vocal cords. This is why teachers, singers, lawyers and salespeople are among the more frequently affected groups.
Gastro-oesophageal reflux
Acid coming back up from the stomach as far as the larynx (known as laryngopharyngeal reflux) irritates the mucous lining even without causing classic heartburn. Typical symptoms are hoarseness in the morning, the sensation of a lump in the throat and frequent throat clearing.
Smoking, alcohol and dry air
Tobacco smoke is the strongest chronic irritant of the larynx. Very dry air in heated rooms, dust, chemical fumes and work in industrial environments can also keep the larynx in a state of persistent inflammation.
Allergies and post-nasal drip
Secretions running from the nose down the back of the throat constantly irritate the larynx and cause a dry cough with hoarseness.
Symptoms
- Hoarseness or a weak, deep voice that tires quickly
- Temporary loss of the voice (aphonia)
- A dry, scratchy or burning sensation in the throat
- A constant need to clear the throat
- A dry, irritating cough
- Mild pain when speaking or swallowing
- In young children — a cough with a distinctive, barking sound and noisy breathing
In adults, laryngitis rarely causes breathing difficulties. In children, because the airways are narrower, the swelling can obstruct the passage of air and requires immediate medical assessment.
How long laryngitis lasts
Acute viral laryngitis usually improves within 3 to 7 days, while the voice may need another week or two to return completely to normal. This is to be expected: the inflammation settles faster than the elasticity of the vocal cords recovers.
If hoarseness persists for more than three weeks, it is no longer a matter of simple, transient laryngitis and a specialist examination is required.
When to see an ENT specialist
We recommend booking a consultation with an ENT specialist if:
- Hoarseness lasts more than three weeks without a clear cause
- Hoarseness keeps coming back over the course of months
- You have difficulty or pain when swallowing
- You feel a lump in the neck or have swollen glands that do not subside
- You cough up blood or lose weight without reason
- You have difficulty breathing or noisy breathing
- You smoke or used to smoke and your voice has changed
- Your voice is your working tool and the symptoms are regularly interfering with it
For children, seek immediate help if the child has difficulty breathing, drools heavily, is unable to swallow or appears tired and drowsy.
How the larynx is assessed
The basic examination includes taking a detailed history of the symptoms and examining the throat and neck. To view the vocal cords directly, laryngoscopy is used — an examination with a thin endoscope, carried out in the outpatient setting and lasting only a few minutes. This examination shows whether there is only inflammation, or nodules, a polyp, a cyst or another lesion that requires specific treatment.
How laryngitis is treated
Treatment depends on the cause. For this reason, self-medication — especially with antibiotics left over from a previous course — does not help and may delay an accurate diagnosis.
General measures
- Resting the voice. Speak as little as possible and in a normal tone. Whispering does not spare the voice — on the contrary, it tires the vocal cords more.
- Hydration. Drinking enough fluids keeps the mucous lining moist.
- Humid air. Humidifying the room helps, particularly during the heating season.
- Avoiding tobacco, including passive exposure, as well as smoky and dusty environments.
Medical treatment
When laryngitis is viral, antibiotics are not needed; treatment is symptomatic and is decided by the doctor. If a bacterial infection is suspected, the therapy is determined by the specialist after assessment. In cases of reflux, the underlying cause is treated, with dietary changes and therapy prescribed by the doctor. When hoarseness is related to incorrect use of the voice or to structural changes of the vocal cords, voice therapy with a speech and language therapist may be recommended or, in selected cases, a minor surgical procedure.
Every course of treatment must be determined individually after examination. This article is for information purposes and does not replace a consultation with an ENT specialist.
How to prevent it
- Do not force your voice when you have a cold
- Learn correct voice technique if you work with your voice
- Do not smoke and avoid smoky environments
- Maintain hand hygiene during the infection season
- Treat allergies and reflux together with your doctor
Frequently asked questions
Should I stay completely silent when I have laryngitis?
Absolute silence for days on end is usually not recommended. It is best to speak as little as possible, in a calm and normal tone, avoiding shouting and whispering. If your voice tires quickly, that is a sign that it needs more rest.
Do antibiotics help with laryngitis?
In most cases acute laryngitis is caused by viruses, so antibiotics have no effect. They are used only when the doctor suspects a bacterial infection after a clinical assessment. Taking antibiotics without indication can do more harm than good.
Why is my voice hoarse only in the morning?
Typical morning hoarseness that improves during the day is often linked to acid reflux during the night, when we are lying flat. This should be assessed by a specialist, because the treatment differs from that of infectious laryngitis.
Can hoarseness be a sign of something serious?
In most cases no, but hoarseness lasting more than three weeks — especially in smokers or when accompanied by pain on swallowing, a lump in the neck or weight loss — always requires examination by laryngoscopy in order to rule out more serious causes.
Are throat sprays and lozenges useful?
They may temporarily ease the scratchy sensation, but they do not treat the cause and do not shorten the course of the illness. Excessive use of menthol products can dry the mucous lining even further. For a suitable treatment plan, please consult a specialist.