Waking Up Hoarse? When to See an ENT Specialist

Waking up hoarse?

We’ve all had that frog in our throat first thing in the morning — maybe it’s acid reflux, maybe the result of sleeping with the ceiling fan on, or perhaps the effects of the cold you just got over?

These are all potential causes for an early morning raspy voice, however if that 7am hoarseness lasts longer than a month, it may be time to see your doctor. 


Two common causes of hoarseness are GERD and LPR – but do you know the difference between the two? Or when it’s time to see the specialist?

By the way, that’s half a trick question. You should always see an ENT specialist for problems effecting the ears, nose, throat or sinuses — a GP will only refer you to them eventually and your insurance might already cover it. So be sure to check with your provider and get directly to the specialist if you can!


If you find that your hoarseness is worse first thing in the morning you could be experiencing gastroesophageal reflux disease or GERD — a digestive disorder that effects the lower esophageal sphincter (LES), a ring of muscle between the esophagus and stomach that helps prevent the flow of stomach acid back up the esophagus.

GERD occurs when a weakened LES muscle allows stomach acid to flow back into the esophagus, causing irritation and a burning sensation that can be accompanied by early morning hoarseness. 

GERD is often brought on by foods and beverages that weaken the LES muscle including alcohol, caffeine and anything high in fat.


If in addition to waking up hoarse you also experience the feeling of something caught in the throat that you cannot clear, a bitter taste, a burning sensation in the throat or difficulty swallowing you may be experiencing the symptoms of laryngopharyngeal reflux or LPR, which is the movement of the stomach acid all the way up into the throat and voice box. While the symptoms of LPR may mimic those of GERD and can often occur simultaneously, LPR sufferers are dealing with more than just heartburn — these problems are directly effecting the throat and vocal chords because the stomach contents have reached the upper respiratory system.

LPR is particularly common in infants who’s esophagus muscles haven’t fully developed. Signs of LPR in infants can include: a barking cough, hoarseness, noisy breathing while sleeping, excessive spitting up or difficulty sleeping for long periods of time.


To help distinguish between GERD and LPR, watch for symptoms directly effecting the throat and voice, including the constant urge to clear your throat, a chronic tickle or feeling of a lump in the throat, prolonged coughing, irritation or a burning sensation in the throat, a bitter taste, or increased phlegm.

Let’s break it down:

  • LPR is when acid in the stomach flows beyond the upper esophageal sphincter (the muscle at the top of the esophagus) all the way up throat and causes irritation and/or changes in the throat (pharynx) or voice box (larynx).  
  • GERD is cause by the back-flow of stomach acid into the esophagus, irritating the sensitive esophageal lining and causing the sensation of heartburn.

If your doctor determines that your hoarseness or other symptoms like heartburn are being caused by GERD, simple lifestyle changes can help alleviate symptoms. This can include avoiding eating close to bed time, eating smaller meals throughout the day, maintaining a healthy weight and possibly using an over the counter or prescription antacid.

And because LPR is directly caused by a problem with the muscles at the top and bottom of the esophagus, it is more difficult to treat and needs further examination.

When To See Your ENT Specialist

If left untreated, stomach acid in the esophagus and/or throat can irritate upper respiratory conditions like asthma or lead to serious problems including throat cancer.

Any symptoms of LPR or GERD lasting more than four weeks are abnormal and need a formal videostroboscopic examination by an ENT specialist to determine the cause and develop appropriate treatment plans. Talk to your insurance provider to understand your coverage and do your best to go directly to a specialist instead of a general practitioner if you can – you can save valuable time by going straight to the specialist!

For patients in Colorado, contact the Colorado Voice Clinic to speak with an ENT specialist to discuss your symptoms and treatment options.


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