Hoarse (Gruff) Voice in Women

Normal Voice

The female voice is typically higher pitched than the male voice but there also differences in resonance and tone that allow us to differentiate between men and women. Simply, a women’s voice is said to be higher and ‘soft’ and whereas the male voice is deeper and ‘rough’ (gruff). Sometimes women may experience a change in the natural voice that is more gruff or hoarse than normal. Depending on the underlying condition contributing to this vocal change, the voice may even whittle down to just a whisper. The sound for the voice is created in the voice box (phonation) with the mouth including the tongue and lips allowing for formation of different words (vocalization or articulation). Changes towards hoarseness indicates a problem with the voice box and is broadly referred to as dysphonia.

Causes of Hoarse Voice in Women

Most acute cases of hoarseness of the voice is associated with infections like infectious laryngitis. Viruses and bacteria are the most common causes and various other symptoms indicative of an infection, like a fever, are also present. A cold and the flu are the more common causes and symptoms only last for a few days. Some degree of hoarseness may be present for a little longer particularly if the viral infection is followed by a secondary bacterial infection.

Another common cause of acute hoarseness of the voice is trauma to the throat. It can be mechanical in nature like with a foreign object lodged in the vocal cords or chemical as is seen with cigarette smoking and acid reflux. Injury to the brain or nerves controlling phonation may also contribute to hoarseness. Medication like asthma inhalers can in some patients contribute to hoarseness. Allergies may cause recurrent bouts of hoarseness and also a nasal tone to the voice when associated with conditions alike allergic rhinitis.

Most women are concerned about hoarseness being associated with virilization. This means that the changes in the vocal cords are associated with higher than normal levels of male sex hormones. Overall, virilization is a very uncommon cause of voice hoarseness in women. It typically develops over a long period of time and is associated with changes in skin (like acne), hair (abnormal facial hair, thinning scalp hair), changes in menstruation (irregular cycle) and difficulty falling pregnant. Virilization is associated with conditions like polycystic ovarian syndrome (PCOS) although there are other rare causes.

A more likely cause of gradual hoarseness of the voice in women is age related changes like atrophy of the vocal cords which is known as presbylarynx. Other possible causes include laryngeal cancer, hypothyroidism, enlarged thyroid gland (goiter) and Cushing’s syndrome. Neuromuscular disorders like myasthenia gravis may also be responsible although this tends to cause a lower volume or whispery tone to the voice that develops over a long period of time.

Less common causes may include dystonia and various diseases that can cause unilateral or bilateral vocal cord paralysis although this is more likely to present with a whispering voice. If no specific condition can be identified, then psychogenic and functional causes need to be considered but only after thorough investigation to exclude various underlying pathologies.

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