Introduction:The health voice production depends on vocal folds vibration and resonance. Anatomical changes of the vocal folds soft tissue (epithelium, ligament, muscle) can cause functional problems results in voice disorders. The vocal folds react to smoking, from irritate the mucous to the tissue changes or dysplasia that degradation of voice performance in daily living. Aim: This study determined the influence of smoking habits to the voice handicap score by Voice Handicap Index score (VHI). Patients and Methods: The design was a retrospective cohort study from 96 adults that identified level of voice fatigue through VHI. They were divided into 3 groups: a group of active smokers, passive smokers and nonsmokers. Chi-square test and regression nominal test was used in this study. Results: Voice fatigue (VHI score > 20) in both active smokers (13.54%) and passive smokers (15.62%) compared with nonsmokers (6.25%), by Chi-square test results was p = 0.047 (p <0.05). Nominal regression test between 3 groups of samples were (RR = 3.0, CI 95% = 0.95 to 9.21) between the group of active smokers and passive smokers (RR = 3.8, CI 95% = 1.23-11.80). Conclusion:Smoking habits influence the voice handicap score in both active smokers and passive smokers compared with nonsmokers. Active smokers have a risk of voice fatigue 3 times than nonsmokers and passive smokers have a risk 3.8 times than non-smokers.