Speech distinguishes humans from other creatures. Speech is one of the last skills acquired by a growing child - it is a complex process and requires coordination from many different centres.

To produce clear speech we need the vocal cords to meet in the mid line and break up the expired air from the lungs into small fragments. This is then converted by the tongue, lips and palate into speech.

Though there are many types of speech impairments like stammering, stuttering, this article concerns itself with altered sound production by the vocal cords - when the voice is gruff - a condition called Hoarseness of Voice.

Hoarseness can be occur due to various causes 

1. Chronic misuse - Using the voice excessively, shouting, yelling or excessive crying can cause Hoarseness. Apart from people who yell and shout this can happen in professions like teachers (in fact the swellings on the vocal cord are called 'Teacher's Nodules'), politicians, auctioneers at vegetable markets (Sabzi Mandi) etc.

2. Lifestyle issues - Smoking, consuming excessive alcohol with ice, eating chilly and spicy food can cause the vocal cords to get inflamed and cause hoarseness.

3. Benign swellings of the vocal cords - polyps, cysts, haematomas of the vocal cords can occur and cause hoarseness. These will need to be surgically removed.

4. Acidity and Reflux - On lying down at night, acid from the stomach can travel to the throat and inflame the posterior (back portion) of the vocal cords to cause hoarseness. That is why it is recommended that you take your last meal of the day at least 3 hours before you go to sleep - to prevent acid reflux from a full stomach.

4. Neurological problems - Sometimes a vocal cord can get paralyzed and this creates a phonatory gap which causes the voice to become weak and breathy.

5. Cancer - Cancer of the Larynx (vocal cords) is a fairly common illness, and in case of persistent hoarseness you must always have yourself checked out by an ENT Specialist to rule out a malignant swelling.

An ENT Clinic will contain equipment to look at your vocal cords and take a biopsy if necessary.

In case your hoarseness is persistent, and specially if you are or have been a smoker, please have yourself checked out soon.