When people get old, all the functions of the body will decline, such as hair will turn gray, eyes will blossom, and ears will go deaf. Therefore, people naturally think that it is normal for the elderly to have hoarse voices. In fact, this idea is wrong. The voice generally does not become hoarse due to the decline of organ functions. The reason why people can speak, sing and make sounds depends on the closed movement of the laryngeal muscles, joints and motor nerves that govern the vocal cords. Among them, the length, thickness, tension and elasticity of the vocal cords play a decisive role in pronunciation. Therefore, it has been reported that as the laryngeal mucosa atrophies in the elderly, the laryngeal nervous system’s control ability decreases, leading to the aging of the vocal folds, which causes the vocal folds to have less elasticity and less motor ability, and therefore the volume becomes smaller, the articulation is weak, the sound quality decreases, and the voice lacks intonation. However, this is only a theoretical extrapolation, and so far, there are no reports in the domestic and international literature that the vocal folds can develop senile degenerative lesions. Clinical data show that changes in people’s voices are more often caused by diseases leading to vocal fold lesions. 1, Short-term hoarseness should be considered as acute inflammation of the vocal cords, which often occurs simultaneously with upper respiratory tract infections. 2, long-term hoarseness is most likely to suffer from chronic inflammation of the vocal cords or vocal cord nodules, which is related to its excessive vocalization or to its original occupation (such as a teacher). 3. Unexplained progressive hoarseness may be due to the presence of laryngeal tumors, such as laryngeal cancer. This occurs mostly in people who drink too much alcohol or smoke too much. 4.Sudden onset of hoarseness with choking symptoms is caused by vocal cord paralysis. Compression by malignant tumors in the adjacent organs of the larynx (such as lung cancer, mediastinal tumors, esophageal cancer, thyroid cancer, etc.) is the main cause of this symptom. 5.The sudden appearance of hoarseness, aphasia and even difficulty in breathing in the elderly should be considered as cerebrovascular lesions. It mostly occurs in people suffering from hypertension, hyperlipidemia and diabetes. 6. Elderly women with low thyroid function may also cause edema of the vocal cords, with low voice tone and hoarseness. It can be seen that hoarseness of voice is a pathology which can reflect not only local diseases of the larynx but also may be related to systemic diseases. Therefore, once hoarseness occurs in the elderly, they should be highly alert and visit the ENT department of the hospital in a timely manner.