Patient information · ENT
Hoarse voice
the three-week rule, and why it matters
Most hoarseness follows a cold or a night of shouting and settles within days. The reason this leaflet exists is a single rule that saves lives: hoarseness lasting more than three weeks needs the voice box examined, because it can be the first and only sign of laryngeal cancer.
Arrange urgent assessment if hoarseness
- has lasted more than three weeks, particularly if you smoke or drink heavily
- comes with difficulty or pain on swallowing, or food sticking
- comes with a lump in the neck
- comes with coughing up blood, or unexplained weight loss
- comes with noisy breathing or breathlessness — this needs emergency assessment
- comes with persistent earache with a normal-looking ear
Referred earache with a normal ear examination, alongside hoarseness or throat symptoms, is a recognised red flag for throat cancer. Noisy breathing with hoarseness suggests airway narrowing and is an emergency — call 999 or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
Common causes
- Laryngitis — viral, following a cold. Settles within one to two weeks.
- Voice overuse — shouting, singing, teaching, prolonged talking over noise.
- Reflux — acid irritating the larynx, often without heartburn. Typically causes morning hoarseness, throat clearing and a sensation of a lump.
- Smoking, which thickens the vocal cords, and alcohol.
- Vocal cord nodules or polyps, from chronic strain.
- Inhaled steroids for asthma, if the mouth is not rinsed after use.
- Thyroid disease, and occasionally a nerve palsy affecting cord movement.
Three weeks is the threshold, not three months
Persistent hoarseness is the commonest presenting symptom of laryngeal cancer, and early laryngeal cancer is highly curable — often with voice-preserving treatment. Late disease is not. Any adult with hoarseness lasting more than three weeks should have the larynx examined, and that applies particularly to smokers, ex-smokers and heavy drinkers. A quick look with a flexible scope settles it in minutes.
What examination involves
A flexible nasendoscopy — a thin flexible camera passed through the nose to view the voice box. It takes a couple of minutes, is done sitting up in the clinic with local anaesthetic spray, and is uncomfortable rather than painful. It gives a direct view of the vocal cords and is the only way to be certain what is going on.
Looking after your voice
Helps
- Rest the voice — but speak normally rather than whispering
- Drink plenty of water; steam inhalation to humidify
- Treat reflux, and avoid late meals
- Warm the voice up gently if you use it professionally
- Rinse the mouth after inhaled steroids
Harms it
- Whispering, which strains the cords more than quiet speech
- Throat clearing and forceful coughing — sip water instead
- Smoking and vaping
- Shouting over background noise; move closer instead
- Excess caffeine and alcohol, which dry the cords
Treatment
- Voice therapy with a speech and language therapist is highly effective for nodules, strain and functional voice problems, and often avoids surgery entirely.
- Treating reflux with acid suppression and lifestyle change, where that is the cause.
- Surgery for polyps, cysts or lesions that do not respond, usually microlaryngeal and day-case.
- Stopping smoking, which improves the voice and removes the main risk factor.
Book an appointment if your voice has been hoarse for more than three weeks, you have a lump in the neck, or you use your voice professionally and it is not recovering. Our ENT team offers same-week flexible nasendoscopy and voice therapy referral.
ENT and nasendoscopy without the wait
Seven days a week, 9am–7pm, on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.