The voice is produced by vibration of the vocal cords. Any abnormality of the vocal cords may cause an alteration of the vocal quality or hoarseness. The most common cause of hoarseness is laryngitis, which is inflammation of the lining of the vocal cords. This can be caused by infection such as an upper respiratory viral infection or common cold, bacterial infection, or croup; or irritating substances such as fumes, postnasal drainage, or gastro-esophageal acid reflux. The underlying cause is treated and the voice returns to normal.
Sometimes hoarseness persists without any obvious cause. This may be due to a singer's nodule resulting from overusing or abusing the voice. This may resolve with voice rest, elimination of the harsh vocal patterns or surgical removal of the nodule. Smokers develop a low pitched voice due to the formation of laryngeal polyps. Polyps are swollen, floppy linings covering the vocal cords and vibrate at a lower frequency. The polyps improve with smoking cessation, but need to be removed. Leukoplakia are worrisome white plaques that form in the larynx when irritated, usually by cigarette smoke. Biopsy will be required to evaluate the possibility of cancer.
Hoarseness that does not resolve by two weeks should be evaluated by a physician who has the capability of looking at the throat with a mirror or fiberoptic scope.