What Is Dysphonia?

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Dysphonia—also known as "hoarseness"—refers to having difficulty making sounds when attempting to speak. It is most frequently caused by a problem with a person's vocal cords or larynx. When someone has dysphonia, the pitch or quality of the voice may change, and—in addition—their voice can sound weak, breathy, scratchy, or husky.

Woman holding throat

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Types of Dysphonia

Nearly one-third of the population experience at least one form of dysphonia at one point in their lifetime. Though there are two main types of dysphonia—spasmodic and muscle tension—there are also several different iterations of disorder, ranging from temporary illnesses to more serious conditions.

Spasmodic Dysphonia

Spasmodic dysphonia—also referred to as laryngeal dystonia—is a rare, chronic condition that affects voice muscles in the larynx. Specifically, the muscles inside the vocal folds make sudden, involuntary movements called spasms, which interfere with vocal fold vibrations (and as a result, impact the sound of your voice). Aside from the vocal cords, spasmodic dysphonia may cause repeated spasms in other parts of the body, including the eyes, face, jaw, lips, tongue, neck, arms, or legs.

Muscle Tension Dysphonia

Muscle tension dysphonia is hoarseness or other changes in the sound or feel of your voice resulting from excessive muscle tension in and around the voice box. It's what's known as a “functional dysphonia,” referring to when a person develops a pattern of muscle use because of irritants, laryngitis, or stress, among other conditions. And even though the initial cause of the dysphonia is no longer a problem, the issue continues because of the excessive tension that comes with voice use.

Other Forms of Dysphonia

  • Laryngitis: A condition where the voice box is swollen, irritated, and/or inflamed, which may result in the loss of speaking voice.
  • Leukoplakia: White patches on the tongue, in the mouth, or on the inside of the cheek.
  • Polyps, nodules, or cysts on the vocal cords: Also known as "vocal cord lesions," these noncancerous growths may be associated with vocal overuse or vocal cord trauma.
  • Precancerous and cancerous lesions: Areas of abnormal cells (dysplasia) that continue to change, and may end up being cancer. Precancerous lesions may appear as a white or red plaque on the vocal cord, while cancerous lesions are often larger and thicker.
  • Vocal cord paralysis or weakness: When one or both of the vocal folds don't open or close properly.

Symptoms of Dysphonia

In addition to feeling hoarse, dysphonia may come with other symptoms including:

  • Hoarseness that lasts more than four weeks (especially if you smoke)
  • Severe changes in voice lasting more than a few days
  • Voice changes, such as it becoming raspy, strained, breathy, weak, higher or lower in pitch, inconsistent, fatigued, or shaky
  • Difficulty breathing
  • Pain when speaking
  • Vocal professionals (singer, teacher, public speaker) who cannot do their job

Causes of Dysphonia

There are a variety of different things that can cause dysphonia. Some of the more common ones include:

  • Acid reflux
  • Allergies
  • Breathing in irritating substances
  • Cancer of the throat or larynx
  • Chronic coughing
  • Colds or upper respiratory infections
  • Heavy smoking or drinking, particularly together
  • Overuse or abuse of the voice (as in shouting or singing), which may cause swelling or growths on the vocal cords

Additionally, less-frequent causes of dysphonia include:

  • Injury or irritation from a breathing tube or bronchoscopy
  • Damage to the nerves and muscles around the voice box (from trauma or surgery)
  • Foreign object in the esophagus or trachea
  • Swallowing a harsh chemical liquid
  • Changes in the larynx during puberty
  • Thyroid or lung cancer
  • Underactive thyroid gland
  • Immobility of one or both vocal cords

Treatment of Dysphonia

Most of the time, dysphonia is something that can be treated at home with rest and time. The following strategies may also help alleviate the symptoms:

  • Talking only when you need to until hoarseness goes away
  • Drinking plenty of fluids to help keep your airways moist (Contrary to popular belief, gargling does not help with this.)
  • Using a vaporizer to add moisture to the air you breathe
  • Avoiding actions that strain the vocal cords, like whispering, shouting, crying, and singing
  • Taking medicines to reduce stomach acid if hoarseness is due to gastroesophageal reflux disease (GERD)
  • Avoiding the use of decongestants, which can dry out the vocal cords
  • Cutting down or stopping smoking, at least until hoarseness goes away

But if the dysphonia lasts more than two or three weeks in an adult or more than one week in a child, it's time to talk to a doctor, who may end up referring you to an otolaryngologist—better known as an ear, nose, and throat doctor, or ENT. Other signs you need to get professional medical help include:

  • Having trouble breathing or swallowing
  • Hoarseness occurring with drooling, particularly in a small child
  • Hoarseness occurring in a child less than 3 months old

In order to help determine what's behind the dysphonia, an ENT will likely perform a laryngoscopy—which involves using a small device to get a better look at the back of a person's throat. After that, they will prescribe the best treatment to meet the patient's needs, which can include:

  • Voice therapy
  • Botulinum toxin (Botox) injections for spasmodic dysphonia
  • Surgery to remove polyps, nodules, or cysts on the vocal cords
  • Anti-reflux medication for patients with hoarseness and signs or symptoms of gastroesophageal reflux disease

Preventing Dysphonia

While some types of dysphonia can't be prevented, others can, making it important to maintain general vocal wellness. Ways to do this include:

  • Avoiding speaking in loud environments
  • Being aware of how much and how loudly you are talking
  • Using a microphone or other type of voice amplification if your job requires a lot of talking (like teaching or public speaking)
  • Drinking plenty of water, usually around 60 ounces daily (This helps thin out mucus)
  • Avoiding large amounts of caffeine, such as caffeinated coffee, tea, and soda
  • Stopping smoking and avoiding secondhand smoke

A Word From Verywell

Most of the time, if you're feeling hoarse, you can trace it back to a particular event, like shouting at a sporting match, singing along at a concert, or having a cold or sinus infection. But that doesn't always explain why you've lost your voice. If you notice changes in your voice, and aren't able to pinpoint a cause—whether it's overuse or an illness—and the hoarseness lasts for two or three weeks, it's time to talk to a doctor. That doesn't necessarily mean that it's something serious. You may just need a professional to take a look at the back of your throat to figure out what might help.

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