Laryngitis

Also called Hoarse voice, Voice loss, Dysphonia

A hoarse voice, usually viral and better in a week. Three weeks is the number that changes it from a nuisance into a referral.

What it is

Inflammation of the voice box, causing hoarseness or loss of voice.

Acute laryngitis is usually viral, follows a cold, and settles within a week or two without treatment. Antibiotics do nothing.

Chronic laryngitis, lasting more than three weeks, has different causes: smoking, reflux, voice overuse, inhaled steroids for asthma used without rinsing, allergy, and alcohol.

**The three-week rule is the important content of this entry.** A hoarse voice lasting more than three weeks needs urgent referral, because it is a recognised presenting symptom of laryngeal and other head and neck cancers. The risk is much higher in smokers and drinkers and over 45, but the rule applies regardless.

Voice rest matters and is widely misunderstood. Whispering strains the vocal cords more than quiet speech, so the advice is to speak quietly and sparingly rather than to whisper.

In children, hoarseness with a barking cough is croup, and hoarseness with drooling and difficulty swallowing may be epiglottitis, which is an emergency.

Voice problems in professional voice users deserve early referral to a voice clinic rather than repeated courses of rest.

Signs you might notice

Hoarseness, a weak voice, or complete voice loss.

A dry or sore throat, and a tickly cough.

A constant need to clear the throat.

Usually with a cold, and settling within one to two weeks.

**Urgent referral: hoarseness lasting more than three weeks**, particularly in a smoker or drinker, or over 45.

Also urgent: a lump in the neck, difficulty or pain on swallowing, persistent earache with a normal ear, coughing blood, or unexplained weight loss.

999: difficulty breathing, noisy breathing, drooling, or a child sitting forward refusing to lie down. See epiglottitis.

In a child: a barking cough with hoarseness is usually croup.

How it can affect day-to-day life

The whisper mistake is worth correcting every time: whispering is worse for the cords than talking quietly.

Voice rest is genuinely difficult for teachers, call handlers, singers and anybody whose job is talking, and it is where most recurrences come from. Amplification, planned quiet periods and voice therapy are the practical answers.

Hydration matters: sipping water through the day, humidifying dry air, and avoiding excessive caffeine and alcohol.

Throat clearing is a habit that perpetuates irritation; swallowing or sipping instead breaks the cycle.

Reflux causing hoarseness often has no heartburn at all, which surprises people; the acid affects the throat rather than the chest.

Inhaled steroid users should rinse and gargle after each dose, and use a spacer, both of which reduce local effects.

Speech and language therapists run voice clinics and are the specialists for persistent voice problems; referral is under-used.

Supporting someone well

Speak quietly and as little as possible. Do not whisper.

Drink plenty, humidify dry air, and avoid smoking and smoky environments.

Stop clearing the throat; sip or swallow instead.

Do not expect antibiotics for acute laryngitis.

**Get a hoarse voice lasting more than three weeks referred urgently.** Do not wait for it to settle.

Rinse and gargle after inhaled steroids, and use a spacer.

Treat reflux if suspected, even without heartburn.

Ask for referral to a voice clinic and speech and language therapy for persistent or recurrent problems.

For a professional voice user, get referred early rather than after months.

Where to get help

A pharmacist for symptom relief; a GP practice for hoarseness lasting more than three weeks.

ENT and a voice clinic for persistent problems.

999 for breathing difficulty or drooling.

ENT UK and Royal College of Speech and Language Therapists for voice information.