Is that frog in your throat a sign of a serious illness?

A cold, cough or excessive screaming at a sporting event or concert could leave you with a scratchy throat and a hoarse voice. 

For the average person, it’s a temporary change that goes away in a few days or weeks. But if that frog in your throat hangs around longer, it could be a sign on a chronic issue.

So what does a normal voice sound like and when should you head to the doctor? Here are answers to some of the common questions I get as a voice and swallowing disorders specialist:

What does a normal voice sound like?

There are variations for what a “normal” voice is and it depends on a person’s baseline voice and surrounding culture. Generally, a “normal” voice has a clear quality without strain, roughness or breathiness. It has the expected pitch for gender, culture and age. A normal voice also has the capacity to be flexible in terms of pitch and volume. It shouldn’t feel like you have to make an effort to talk. 

How does our voice change as we age?

As we age from children to adults, the pitch of our voice decreases and resonance increases, with some expected instability in pitch during puberty, especially in males. When we enter our senior years, our voice can change as well, becoming less consistent, rougher in quality, lower in volume and it can take more effort to talk. Pitch can also drop in women and rise in men.

What are some causes of chronic voice change?

There are many causes of chronic voice change. Some examples include:

• nerve weakness due to surgery in the brain, neck or chest 
• allergies 
• tobacco usage
• medication side effects
• autoimmune disorders
• infections 
• hypothyroidism
• diabetes
• tumors or cancers
• trauma
• intubation
• tracheal stenosis (narrowing of the windpipe)
• nodules, cysts and polyps
• hemorrhages
• muscle tension
• heartburn
• neurological disorders

What are the risk factors for developing a voice disorder?

People who use their voice a lot such as singers, clergy, attorneys, teachers, fitness instructors, coaches and telemarketers are at risk of developing a voice disorder. Other risk factors include aging, neurological conditions, certain medication usage, diabetes, radiation therapy, trauma to the throat and history of surgery on the brain, neck or chest.

What symptoms warrant urgent or even emergency evaluation in people who are having voice issues?

Any hoarseness that persists beyond four weeks should be evaluated by an otolaryngologist performing a laryngoscopy to look at the vocal folds. 

Neck masses, noisy or worsening breathing, difficulty swallowing, and neurological warning signs like weakness, numbness, slurred speech, facial paralysis or change in mental status should prompt an urgent evaluation by a voice disorders specialist. Seek care at an emergency department for concerns about swelling or trauma affecting breathing, or an acute stroke.  

Professional singers experiencing voice issues should also seek an urgent referral. Some conditions if left untreated could cause permanent changes or damage to your voice.

How are voice disorders diagnosed?

An otolaryngologist who specializes in voice disorders will obtain a history, do a physical exam of the head and neck as well as a voice analysis, and perform a laryngoscopy to look at the vocal cords. They may also work with a speech language pathologist to do a recorded laryngeal stroboscopic examination to check the vibration and closure of the vocal folds.

What treatments are available for voice disorders?

Treatment for voice disorders depends on the diagnosis but may include therapy, medication, procedures or surgery. 

How can I keep my voice healthy?

You can keep your voice healthy by staying hydrated. Use a microphone in large or noisy spaces so you don’t stain your voice by yelling. Rest your voice during times of heavy voice usage. Avoid smoke and other irritants. Try to avoid coughing or throat clearing. Use a humidifier when the air is dry and try not to take medications that cause dryness unless needed. Limit alcohol and caffeine intake. Don’t eat foods that promote acid reflux and don’t eat or drink shortly before bedtime. 

Brandon Kim is a laryngologist in the voice and swallowing disorders clinic at The Ohio State University Wexner Medical Center.