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Hoarseness is defined as a raspy or strained voice which can be due to many causes. One of the most common causes of hoarseness is voice overuse, misuse or abuse. Generally people who use their voice a great deal often have voice problems, such as parents of young children, teachers, clergy, and professional singers, actors and performers.

However, in addition to length of time talking and the style of how one speaks, other factors may play a role in the development of voice issues, in particular acid reflux disease. Stomach acid can affect the voice in two different ways, either from acid reflux coming up from the stomach, or from acidic foods coming down from the mouth after being swallowed and then directly irritating the throat and vocal folds. The direct injury to the vocal fold is via “tissue bound pepsin” that gets activated in acidic environments, such as when drinking sugary sodas, eating processed foods, citrus fruits (pineapple, orange, grapefruit, lemon, lime), vinegar, and tomato.

The vocal folds can also be directly irritated from noxious, carcinogenic substances like cigarette or cigar smoke.

Another cause of hoarseness may be some type of bump or tumor on the vocal fold itself, or even from a vocal fold that is not moving well, for example a paralyzed vocal fold.

To properly treat the hoarseness requires an accurate diagnosis of why the individual is hoarse. The best way to make an accurate diagnosis is to have a look at the vocal folds in action via tests ear, nose and throat (ENT) doctors perform, called Transnasal Flexible Laryngoscopy (TFL) or Laryngeal Videostroboscopy. Each test uses some type of ultra-thin flexible or rigid camera to look at the vocal folds moving in real time with the patient wide awake. 

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Once the cause of the hoarseness is determined then treatment is tailored to the source of the problem. Very commonly, acid reflux disease, generally the Throatburn reflux type, also know as LaryngoPharyngeal Reflux (LPR) or “silent“ reflux, can either cause, or contribute to, the hoarseness as a result of the vocal folds being swollen by acid injury. The treatment is typically multifaceted, often including a form of physical therapy called Speech Therapy, in addition to dietary and medical therapies. Dietary treatment requires low acid diets, along with certain lifestyle changes such as avoiding late night eating and staying up for at least 3 hours after one’s last meal.  

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