Why do I sometimes wake up hoarse?


In order to grasp the concept of dysphonia, it’s essential to distinguish between two related terms: aphonia and dysphonia. Aphonia refers to a complete loss of voice, which doesn’t seem to align with the concerns expressed in the email. Dysphonia, on the other hand, entails an alteration in vocal perception, wherein an individual may experience a voice that deviates from their perceived normal voice. Defining dysphonia precisely proves challenging due to the multifaceted nature of voice, influenced by cultural factors, emotional states, and environmental contexts. Thus, labeling a voice as “normal” becomes subjective, often encompassing pleasant timbre, appropriate pitch for one’s age and gender, and adequate volume.

Understanding Dysphonia

Dysphonia serves as a symptom that may or may not indicate an underlying localized vocal cord disorder or systemic illness. Its impact on quality of life varies among individuals, with professionals relying on their voice for work (such as singers, teachers, teleoperators, and radio announcers) facing distinct challenges compared to those who do not depend on their voice as a primary tool.

The Complexity of Vocal Production

The production of voice is intricate, primarily involving the vibration of muscles known as vocal cords. When addressing a reader’s concerns about morning voice alterations, various factors come into play, including age, accompanying symptoms like itching or burning sensations, history of gastroesophageal reflux, vocal habits, and smoking status. Additionally, inquiries regarding any other medical conditions or past cervical surgeries prove relevant in diagnosing dysphonia.

Functional vs. Organic Dysphonia

Dysphonia can be categorized into functional and organic types, each demanding distinct diagnostic and treatment approaches. Functional dysphonia, likely experienced by the reader if their voice gradually restores throughout the day, stems from behavioral factors rather than structural abnormalities. Conversely, organic dysphonia arises from vocal cord lesions, which necessitate different management strategies.

Causes of Vocal Cord Lesions

Frequently, organic lesions result from vocal misuse or abuse. Educators, for instance, may develop nodules due to inadequate vocal training, leading to progressive vocal cord damage and subsequent dysphonia. While professionals in voice-related fields often undergo vocal training, individuals like teleoperators and teachers may lack such preparation, increasing their susceptibility to vocal cord injuries like nodules, polyps, or edema.

Various factors contribute to vocal cord lesions, including:

  • Vocal misuse or abuse
  • Smoking
  • Congenital abnormalities
  • Pharyngolaryngeal reflux
  • Neurological or endocrine disorders

Treatment Approaches

The treatment of dysphonia hinges upon identifying its underlying cause. Addressing tobacco use, for instance, involves smoking cessation, while managing reflux entails lifestyle modifications like reducing caffeine intake, avoiding heavy meals, and abstaining from alcohol consumption. Individuals engaging in vocally demanding professions, such as teaching or coaching, benefit from vocal warm-ups, speech pauses, relaxation exercises, and voice modulation techniques to prevent overexertion.

It’s crucial to acknowledge that each individual’s vocal muscles vary, akin to other muscular capacities, impacting their susceptibility to dysphonia. Consequently, not everyone possesses the endurance to sustain prolonged vocal activities without experiencing voice alterations.


In summary, understanding the root cause of dysphonia is imperative for effective management. Despite presenting similar symptoms of abnormal voice, dysphonia warrants diverse treatment modalities, ranging from medical and surgical interventions to speech therapy. Notably, persistent dysphonia exceeding 15 days, particularly in individuals with risk factors like smoking, merits evaluation by an otolaryngologist, as it could signify a severe underlying condition such as cancer or neurological pathology.

Elisa Gil-Carcedo, Section Chief of Otolaryngology at the Río Hortega University Hospital and Associate Professor at the University of Valladolid, offers valuable insights into the multifaceted nature of dysphonia and underscores the importance of tailored interventions based on individual needs. By addressing the nuances of dysphonia, healthcare professionals can effectively alleviate symptoms and enhance patients’ quality of life.

About “Nosotras Respondemos”

“Nosotras Respondemos” is a weekly scientific advisory column sponsored by the L’Oréal-Unesco “For Women in Science” program, dedicated to addressing readers’ queries on science and technology. Operated by members of the Association of Women Researchers and Technologists (AMIT), this initiative provides expert insights into various scientific disciplines. Readers are encouraged to submit their questions via email to [email protected] or through the designated hashtag #nosotrasrespondemos.

It’s important to note that the advice provided in this column serves as general guidance and does not replace personalized medical consultations. Individuals seeking specific medical advice should consult their healthcare professionals for tailored recommendations and treatment plans. Through “Nosotras Respondemos,” AMIT aims to bridge the gap between scientific knowledge and public understanding, fostering informed decision-making and promoting health and well-being within communities.