Hoarseness is a harsh, rough quality to the voice. Hoarseness is generally caused by irritation of, or injury to, the vocal cords. The voice box, or larynx, is the portion of the respiratory (breathing) tract containing the vocal cords which produce sound. It is located between the pharynx and the trachea. The larynx, also called the voice box, is a 2-inch-long, tube-shaped organ in the neck. We use the larynx when we breathe, talk, or swallow. Its outer wall of cartilage forms the area of the front of the neck referred to as the "Adams apple." The vocal cords are two bands of muscle that form a "V" inside the larynx. Hoarseness can be caused by a number of conditions. The most common cause of hoarseness is inflammation of the vocal cords from virus infection. Hoarseness can also be caused by bacterial infection, overuse of the voice (such as from yelling or singing), inhalation of irritants (smoking, etc.), chronic sinusitis, reflux of acid from the stomach (GERD), tuberculosis, syphilis, and cancer of (or that has spread to) the larynx. Cough suppressants are sometimes used to prevent recurrent irritation of the vocal cords from coughing. Hoarseness that persists for longer than two weeks should be evaluated by doctor.