The term hoarseness applies to any change in the quality of voice (Bruch JM, Kamani DV. Hoarseness in adults. UpToDate.com. Last updated: Aug 07, 2024. Last accessed: Jan 4, 2023., with the voice acquiring a coarse and breathy quality (Grist WJ, Clinical Methods. Chapter 125. The History, Physical, and Laboratory Examinations. Butterworths, Boston, 1990). For a pulmonologist to be the first point of contact of a patient with presenting with hoarseness of the voice is unusual. However a few pulmonary, and several extrapulmonary conditions are associated with this symptom, and the pulmonologist should be aware of this. The most important cause by far in pulmonary practice is left recurrent laryngeal nerve palsy due to carcinoma of the lung: very frequently this diagnosis will already have been made by an ENT specialist before referral to the pulmonologist. The chapter discusses the causes of hoarseness that the pulmonologist needs to be cognisant of, and the strategies for diagnosing these conditions.