Mrs T, a 53 year old woman presents with persistent hoarseness over the past three weeks. She has come to consult you because the hoarseness has not improved, and she is due to travel overseas in ten days, as part of a choir that will tour Europe for two weeks
Inflammatory or irritant
Neoplastic
Neuromuscular and psychiatric
Associated systemic diseases
Allergies and irritants (e.g., alcohol, tobacco)
Environmental irritants
Infections (upper respiratory infection, including
viral laryngitis)
Inhaled corticosteroids
Laryngopharyngeal reflux
Vocal abuse
Dysplasia
Laryngeal papillomatosis
Squamous cell carcinoma
Multiple sclerosis
Muscle tension dysphonia
Myasthenia gravis
Parkinson disease
Psychogenic (including conversion aphonia)
Spasmodic dysphonia (laryngeal dystonia)
Acromegaly
Amyloidosis
Hypothyroidism
Inflammatory arthritis (cricoarytenoid joint
involvement)
Sarcoidosis
Nerve injury (vagus or recurrent laryngeal nerve)
Cough, rhinorrhea, sneezing, watering eyes, throat clearing, wheezing, other signs of asthma
Cough, odynophagia, palpable lymph nodes, rhinorrhea, sneezing, watering eyes
Dysphagia, heart burn, hemoptysis, history of heavy alcohol use, smoking or tobacco use, odynophagia, palpable lymph nodes, stridor, symptoms of airway obstruction, weight loss
Dysphagia, heart burn, history of heavy alcohol use, throat clearing
Professional voice user or untrained singer
Stridor, symptoms of airway obstruction
Leukoplakia
Sensitivity to heat, spicy foods, other irritants, history of smoking or tobacco use
Wheezing, other signs of asthma, throat clearing
Recent head, neck, or chest surgery
Direct trauma (intubation)
Recent intubation or laryngeal procedure
Breathy, halting, strangled, strained
Hoarse, husky, muffled, or nasal-sounding, vocal fatigue, soft (loss of volume)
Low pitched, raspy or harsh, strained, effortful phonation, strained, vocal fatigue
Thick, deep voice and slowed
speech
Honking
Low pitched
Dysphagia, odynophagia
Breathy
Hoarseness worse later in the day. vocal fatigue
Scanning speech and dysarthria
Hoarseness worse early in the day, low pitched, raspy or harsh, strained
Reinke's oedema
roughness, vocal fatigue, and low-pitched voice
History of smoking or tobacco use
Vocal cord nodules (singer’s nodules): hoarsensss
fluctuates day-to-day, improving on weekends, with
rest, or with speech therapy. This is common in
young pts, due to vocal abuse – elicit a social and
occupational hx (e.g. in teachers, singers, actors).
Vocal cord polyps, cysts: hx is as for vocal cord
nodules, but do not improve on speech therapy.
Flexible nasoendoscopy or stroboscopy may reveal
subtle differences from nodules.