Voice problems, such as hoarseness, that last more than 2 weeks or come back frequently may point to a condition other than laryngitis. These conditions may cause damage to the voice box, or larynx.

Chronic conditions that can damage the larynx include:

• Chronic reflux laryngitis. Gastroesophageal reflux disease (GERD) produces acidic secretions that can damage the mucous lining of the larynx. When reflux occurs frequently, tissue may swell or thicken, and sometimes open sores (ulcers) develop. Excess mucus, throat clearing, a choking feeling, and periodic speech and voice problems can result.
• Vocal cord lesions. Ulcers or growths (such as cysts, polyps, or nodules) on the vocal cords can affect the voice. These lesions may be caused by improper use of the voice over an extended period, chronic viral infection (such as sinusitis), smoking, cancer, or long-term exposure to allergens or irritants.
• Muscle tension dysphonia. This is a voice disorder that causes hoarseness, neck pain, and poor voice range and quality. It is a result of habitual and improper use of muscles around the vocal cords. The behavior often begins as a means to compensate for strain on other voice box muscles during a viral infection or from overuse.
• Neurological voice disorders. Parkinson's disease and similar disorders can result in a problem controlling volume and speech rhythm. The voice may become soft, and speech can be rapid and slurred.
• Age-related muscular changes of the vocal cords. Weakness or degeneration of muscle around the vocal cords can result in a thin voice, with decreased range, and occasional loss of sound.
• Structural immobility of the vocal cords. Damage to one or both vocal cords, such as a traumatic injury or nerve problems, can prevent them from working properly. Difficulty speaking may result.
• Cancer of the larynx (laryngeal cancer).
• Vocal cord paralysis. Paralysis may be caused by problems in the neck, the thyroid gland, or even in the chest.

Diagnosing and treating these conditions helps prevent recurring symptoms or complications. Common treatments include voice training, medicines, injections of fat or collagen, or surgery. Laryngeal cancer may require more treatments, such as radiation therapy.