• The most common causes are post-viral laryngitis and irritation of the upper airway mucosa, especially during respiratory infection season.
• Treatment – symptomatic: hydration, air humidification, lozenges, inhalations, throat sprays, and nasal rinses; antibiotics are usually not indicated.
• Additional causes: acid reflux, smoking, dry air, and vocal strain; treatment includes PPIs and lifestyle changes.
• When to see an ENT specialist: if hoarseness lasts longer than 3 weeks, fiberoptic laryngoscopy is required, with additional tests as needed (endocrine or imaging).
• New approaches: speech therapy exercises and HRV biofeedback to relax the larynx in functional dysphonia; muscle relaxants or botulinum toxin only in selected cases

Hoarseness, or dysphonia, is an unpleasant symptom that most often has no serious cause, is short-lived, and does not lead to lasting consequences—yet it can still temporarily interfere with everyday functioning. In early autumn, we encounter a wide range of respiratory viruses, most of which affect the upper respiratory tract and cause local irritation and inflammation of the mucosa. From milder pathogens such as RSV, metapneumovirus, and adenovirus to more severe infections like influenza or COVID-19, one common symptom is hoarseness—ranging from a rough, strained voice to complete voice loss (aphonia).

The underlying cause is inflammation of the laryngeal mucosa, or laryngitis, which also involves the vocal cords. As the virus enters the cells of the respiratory and oral mucosa and the body mounts a defense, local inflammation develops: mucus production increases, the mucosa and vocal cords swell, and symptoms are often accompanied by pain—from a burning sensation to dull pain when swallowing. Increased secretions frequently drain downward along the nasopharynx and oropharynx, sometimes without nasal congestion or the need to blow the nose. This can be confusing for patients, but symptomatic treatment with nasal sprays and medications is usually the first line of relief.

Postnasal drip can trigger a reflex cough, which in turn may worsen symptoms of acid reflux—meaning the causes of an irritating, prolonged cough are often multiple. After a viral infection, cough alone can persist for 6–8 weeks, an important point to emphasize to parents of young children who may cough intermittently throughout much of the winter in daycare or group settings. Gastric acid reflux can further irritate and damage the vocal cords, worsening hoarseness and voice loss. In smokers, even temporary abstinence from cigarettes—as well as e-cigarettes and vaping devices—is crucial in these situations.

Treatment and management measures

It is essential to reduce exposure to secondhand smoke, enclosed and poorly ventilated spaces, and dry indoor air, as well as to regularly air out the rooms we spend time in. Humidifying the air can also be helpful, especially when a few drops of essential oils are added (such as peppermint, eucalyptus, lavender, or pine needle oil). Some essential oils are specifically refined and suitable for use in inhalers for both children and adults, particularly those based on pine needles.

Throat pastilles are also useful for moisturizing the throat—especially those containing sage, plantain, or honey—along with adequate daily hydration (water, teas, electrolytes). In cases of sore throat, various herbal throat sprays with or without analgesics can be helpful, as well as gargling with strong sage tea or saline solutions. When hoarseness is caused by sinus congestion and increased secretions, regular nasal rinsing with saline or hypertonic saline sprays is necessary, as these more effectively remove viruses from the mucosa. Effervescent calcium with added vitamin C once daily has shown benefit in some cases, but the key measure remains voice rest and avoidance of all irritants.

What if hoarseness doesn’t go away?

In some cases—especially in people who use their voice professionally and frequently (such as opera singers, broadcasters, or presenters)—hoarseness can become prolonged, often due to returning to work without adequate voice rest. Newer therapeutic approaches, in addition to pharmacological treatment, include speech therapy exercises and a specific type of biofeedback—HRV (heart rate variability) biofeedback. Under medical supervision and with the use of special sensors, patients are guided through paced breathing exercises aimed at reducing sympathetic tension, relaxing the larynx, and improving voice quality in cases of functional dysphonia.

If hoarseness persists for more than three weeks, without a clear cause and despite symptomatic treatment, an ENT specialist evaluation is necessary. Fiberoptic laryngoscopy allows visualization of the larynx and vocal cords, while selected laboratory tests can help identify possible endocrine or inflammatory causes. MRI or CT imaging of the neck is indicated in patients with long-lasting hoarseness, and in long-term smokers, tumor markers and low-dose CT of the lungs should also be considered. In patients with allergies (especially to dust or mites), antihistamines and intranasal corticosteroids may be introduced. Systemic corticosteroids (tablets or injections) require caution due to potential side effects and are reserved for exceptional cases. Antibiotics are not indicated for hoarseness alone. In some situations, short-term anxiolytics or muscle relaxants may be used to reduce spasm, and in selected cases, microdoses of botulinum toxin injected directly into laryngeal muscles have been explored.

Although hoarseness is most often benign and post-infectious, typically resolving within 2–3 weeks, it can significantly impair work and daily functioning. Voice rest is essential, along with adequate hydration, smoking cessation, and avoidance of smoky environments, concerts, and cold carbonated drinks. Regular inhalations and the use of throat lozenges, honey, and symptom-adapted syrups (antitussives, expectorants, and similar) can also provide relief.