Lesser-known causes of hoarseness

Written by: Mr Kalpesh Patel
Edited by: Nicholas Howley

The most common causes of a hoarse voice include an inflammation of the airways from infection, vocal cord nodules due to overuse, or acid reflux. However, a sizeable number of people have a hoarse voice due to various lesser-known conditions, as explained by leading ENT surgeon Mr Kalpesh Patel below.

If you have a hoarse voice, it’s always worth getting it checked by a doctor – many of the causes are straightforward to diagnose and treat. It’s also important to check for any early signs of cancer. Although it is very rare to get throat cancer, the earlier it is detected the better your outcomes will be.

Respiratory tract infections, vocal cord nodules, and acid reflux are the most common and well-known causes of hoarseness. Here are some of the lesser known causes:


Some drugs can result in inflammation of the vocal cords. The most common example of this is inhalation therapy with steroids in the treatment for asthma , which results in a chemical irritation of the larynx with resulting hoarseness.

Functional dysphonia

Functional dysphonia , is a common problem where your voice quality is poor but there is no obvious physical problem with your nerves, larynx or voice box. It is best treated by speech therapy.

Vocal cord paralysis

Vocal cord paralysis can be due to injury to one of the recurrent laryngeal nerves which control the muscles in your larynx. It can sometimes occur during neck surgery, particularly surgery for the thyroid glands, but it can sometimes be caused by a severe infection or cancerous growths. Tumours of the lung can also damage the nerve that supplies the vocal cords. Treatment can involve voice therapy or further surgery.

Tumours in the throat

In rare instances, particularly in smokers, tumours can arise affecting the vocal cords. Because they cause irregularity of the normal smooth surface of the vocal cords, hoarseness is often a presenting symptom. There can often be an associated cough together with the presence of blood in sputum.

Hoarseness can be a presenting symptom for a cancerous diagnosis. Hoarseness which lasts for more than six weeks, particularly in patients who are smokers, needs to be investigated by an ENT specialist. Other red flag symptoms include associated difficulty in swallowing, weight loss, referred pain to the ear and the coughing up of blood ( haemoptysis).

When to see a doctor

As already mentioned, it’s always worth visiting a doctor if you have a hoarse voice or you notice any other change in your voice that is unexplained. In most instances, when it is due to an upper respiratory infection, it lasts for no more than 10 days to 2 weeks. It is when symptoms persist for more than 6-8 weeks that an opinion from an ear, nose and throat specialist is required to rule out any serious causes.

By Mr Kalpesh Patel
Otolaryngology / ENT

Mr Kalpesh Patel is a leading Consultant ENT surgeon who has run his own practice, The London ENT Clinic, since 2009. He specialises in sinus surgery and rhinoplasty, and has exceptional experience in nasal allergies, sinus disease, hoarseness, ENT infections and the management of chronic cough.

Mr Patel qualified in medicine in 1984, graduating from St Bartholomew's Medical College, before going on to achieve fellowship of the Royal College of Surgeons. After completing higher surgical training at King's College, the Royal Marsden and St Mary's hospitals, He then became a consultant ENT Surgeon at St Mary’s Hospital, London. 

As well as a long-standing medical career, Mr Patel has also contributed hugely to teaching and training future medical professionals. He taught anatomy and physiology at the University of St Andrews in Scotland  and has been an honorary senior lecturer in ENT surgery at Imperial College London for the last 25 years.

Mr Patel was the inaugural president of the British Society of Rhinoplasty Surgeons and lectures frequently on all aspects of rhinoplasty, both nationally and internationally. Mr Patel is also widely published and has written more than 30 peer-reviewed articles, most recently focusing on functional rhinoplasty.

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