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53 year old woman with hoarseness (Irritants (Allergies and irritants…
53 year old woman with hoarseness
Laryngeal causes
acute
(< 3 weeks)
Laryngitis
Hoarseness
Loss of voice
Odynophagia
Improving with vocal rest
Due to URTI or acute vocal strain
peritonsillar
abscess
‘Hot potato’ voice (muffled, thickened)
Throat pain
Odynophagia
Trismus
Pyrexia
Chronic
(> 3 weeks)
Laryngitis
Hoarseness
Frequent throat clearing
Persistent cough or dyspepsia
Due to irritants, laryngopharyngeal reflux or muscle tension dysphonia
Vocal cord nodules (singer's nodules)
hoarseness fluctuates day-to-day
social and occupational history
improves with rest
improves with speech therapy
Vocal cord polyps,cysts
similar to vocal cord nodules
does not improve with speech therapy
Reinke's edema (polypoid corditis)
Husky, low-pitched voice
"sounding like a man"
Neoplastic
Laryngeal
cancer
Persistent
Progressive
non-fluctuating hoarseness
Weight loss
more than 50 years old
benign
neoplasms
laryngeal papillomatosis
Neurological causes
recurrent laryngeal nerve damage
Malignancy:
Lung CA
Thyroid CA
Cough
Haemoptysis
Weight loss
palpable thyroid nodules
Iatrogenic injury:
Recent head, neck or chest surgery
Aneurysm of aortic arch
Neuromuscular
and psychiatric
Myasthenia gravis (fluctuating hoarseness, sometimes associated with dysphagia and stridor, fatigue voice with repetitive use, recover with rest)
Multiple sclerosis
Parkinson disease (hypophonic with a soft breathy and monotone quality)
Muscle tension dysphonia
Irritants
Allergies and irritants (alcohol, tobacco)
Inhaled corticosteroids
GERD
URTI
Associated systemic disease
Acromegaly
Amyloidosis
Hypothyroidism
Inflammatory arthritis
Sarcoidosis