Hoarseness may be caused by either:

• An abnormality of the structure of the vocal cords which can be generalised e.g. laryngitis, or localised e.g. a cyst
• An abnormality of the movement of the vocal cords e.g. recurrent laryngeal nerve palsy or arthritis affecting the laryngeal joints
• Malignancy should always be excluded as the cause of hoarseness

We will discuss the structure and function of the larynx in order to demonstrate how pathological processes can cause hoarseness.

In terms of voice, the equivalent to hoarseness will be an abnormal cry in children before the development of speech. Hoarseness describes a rough quality to the voice. Dysphonia encompasses the spectrum of voice disorders.

The quality and severity of voice disturbance vary markedly depending on the pathology. For example, it may be so severe that it makes it difficult for the patient to make themselves understood or maybe a subtle abnormality affecting a professional singer’s singing voice in a certain register.

The cause of hoarseness is often multi-factorial and the classification of hoarseness is not necessarily straightforward. For example, disorders of the movement of vocal cords can often lead to structural abnormalities, functional factors can be difficult to define and the place of some factors e.g. acid reflux is controversial.

Respiratory pathology can exacerbate hoarseness by altering the control of the air stream presented to the larynx.