I’ve recovered from a cold but I still have a hoarse voice. What should I do?

Cold, flu, COVID and RSV^[1] have been circulating across Australia this winter^[2]. Many of us have caught and recovered from one of these^[3] common upper respiratory tract infections.

But for some people their impact is ongoing. Even if your throat isn’t sore^[4] anymore, your voice may still be hoarse or croaky.

So what happens to the voice when we get a virus? And what happens after?

Here’s what you should know if your voice is still hoarse for days – or even weeks – after your other symptoms have resolved.

Why does my voice get croaky during a cold?

A healthy voice is normally clear and strong. It’s powered by the lungs, which push air past the vocal cords to make them vibrate. These vibrations are amplified in the throat and mouth, creating the voice we hear.

The vocal cords are two elastic muscles situated in your throat, around the level of your laryngeal prominence, or Adam’s apple. (Although everyone has one, it tends to be more pronounced in males.) The vocal cords are small and delicate – around the size of your fingernail. Any small change in their structure will affect how the voice sounds.

When the vocal cords become inflamed – known as laryngitis – your voice will sound different. Laryngitis is a common part of upper respiratory tract infections, but can also be caused through misuse.

Catching a virus triggers the body’s defence mechanisms. White blood cells are recruited to kill the virus and heal the tissues in the vocal cords. They become inflamed, but also stiffer. It’s harder for them to vibrate, so the voice comes out hoarse and croaky.

In some instances, you may find it hard to speak in a loud voice or have a reduced pitch range, meaning you can’t go as high or loud as normal. You may even “lose” your voice altogether.

Coughing can also make things worse. It is the body’s way of trying to clear the airways of irritation, including your own mucus dripping onto your throat (post-nasal drip^[6]). But coughing slams the vocal cords together with force.

Chronic coughing can lead to persistent inflammation and even thicken the vocal cords. This thickening is the body trying to protect itself, similar to developing a callus when a pair of new shoes rubs.

Thickening on your vocal cords can lead to physical changes in the vocal cords – such as developing a growth or “nodule” – and further deterioration of your voice quality.

How can you care for your voice during infection?

People who use their voices a lot professionally – such as teachers, call centre workers and singers – are often desperate to resume their vocal activities. They are more at risk^[8] of forcing their voice before it’s ready.

The good news is most viral infections resolve themselves. Your voice is usually restored within five to ten days of recovering from a cold.

Occasionally, your pharmacist or doctor may prescribe cough suppressants to limit additional damage to the vocal cords (among other reasons) or mucolytics, which break down mucus. But the most effective treatments for viral upper respiratory tract infections are hydration and rest.

Drink plenty of water, avoid alcohol and exposure to cigarette smoke. Inhaling steam^[10] by making yourself a cup of hot water will also help clear blocked noses and hydrate your vocal cords.

Rest your voice by talking as little as possible. If you do need to talk, don’t whisper – this strains the muscles^[11].

Instead, consider using “confidential voice^[12]”. This is a soft voice – not a whisper – that gently vibrates your vocal cords but puts less strain on your voice than normal speech. Think of the voice you use when communicating with someone close by.

During the first five to ten days of your infection, it is important not to push through. Exerting the voice by talking a lot or loudly will only exacerbate the situation. Once you’ve recovered from your cold, you can speak as you would normally.

What should you do if your voice is still hoarse after recovery?

If your voice hasn’t returned to normal after two to three weeks^[13], you should seek medical attention from your doctor, who may refer you to an ear nose and throat specialist.

If you’ve developed a nodule, the specialist would likely refer you to a speech pathologist who will show you how to take care of your voice. Many nodules can be treated^[14] with voice therapy and don’t require surgery.

You may have also developed a habit of straining your vocal cords, if you forced yourself to speak or sing while they were inflamed. This can be a reason why some people continue to have a hoarse voice even when they’ve recovered from the cold.

In those cases, a speech pathologist may play a valuable role. They may teach you to exercises that make voicing more efficient. For example, lip trills^[15] (blowing raspberries) are a fun and easy way you can learn to relax the voice. This can help break the habit of straining your voice you may have developed during infection.

References

1. ^{^} RSV (theconversation.com)
2. ^{^} circulating across Australia this winter (www.abc.net.au)
3. ^{^} one of these (theconversation.com)
4. ^{^} sore (theconversation.com)
5. ^{^} Pepermpron/Shutterstock (www.shutterstock.com)
6. ^{^} post-nasal drip (www.health.harvard.edu)
7. ^{^} Pepermpron/Shutterstock (www.shutterstock.com)
8. ^{^} more at risk (www.ncbi.nlm.nih.gov)
9. ^{^} Rawpixel.com/Shutterstock (www.shutterstock.com)
10. ^{^} Inhaling steam (www.healthdirect.gov.au)
11. ^{^} strains the muscles (www.sciencedirect.com)
12. ^{^} confidential voice (www.instagram.com)
13. ^{^} two to three weeks (www.healthdirect.gov.au)
14. ^{^} treated (britishvoiceassociation.org.uk)
15. ^{^} lip trills (www.youtube.com)