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Mrs T, a 53 year old woman presents with persistent hoarseness over the…
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
Allergies and irritants (e.g., alcohol, tobacco)
Cough, rhinorrhea, sneezing, watering eyes, throat clearing, wheezing, other signs of asthma
Environmental irritants
Infections (upper respiratory infection, including
viral laryngitis)
Cough, odynophagia, palpable lymph nodes, rhinorrhea, sneezing, watering eyes
Inhaled corticosteroids
Wheezing, other signs of asthma, throat clearing
Laryngopharyngeal reflux
Dysphagia, heart burn, history of heavy alcohol use, throat clearing
Hoarseness worse early in the day, low pitched, raspy or harsh, strained
Vocal abuse
Professional voice user or untrained singer
Direct trauma (intubation)
Recent intubation or laryngeal procedure
Neoplastic
Dysplasia
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.
Laryngeal papillomatosis
Stridor, symptoms of airway obstruction
Squamous cell carcinoma
Dysphagia, heart burn, hemoptysis, history of heavy alcohol use, smoking or tobacco use, odynophagia, palpable lymph nodes, stridor, symptoms of airway obstruction, weight loss
Leukoplakia
Sensitivity to heat, spicy foods, other irritants, history of smoking or tobacco use
Reinke's oedema
roughness, vocal fatigue, and low-pitched voice
History of smoking or tobacco use
Neuromuscular and psychiatric
Multiple sclerosis
Scanning speech and dysarthria
Muscle tension dysphonia
Low pitched, raspy or harsh, strained, effortful phonation, strained, vocal fatigue
Myasthenia gravis
Hoarseness worse later in the day. vocal fatigue
Parkinson disease
Hoarse, husky, muffled, or nasal-sounding, vocal fatigue, soft (loss of volume)
Psychogenic (including conversion aphonia)
Spasmodic dysphonia (laryngeal dystonia)
Breathy, halting, strangled, strained
Nerve injury (vagus or recurrent laryngeal nerve)
Recent head, neck, or chest surgery
Associated systemic diseases
Acromegaly
Thick, deep voice and slowed
speech
Amyloidosis
Hypothyroidism
Low pitched
Inflammatory arthritis (cricoarytenoid joint
involvement)
Dysphagia, odynophagia
Breathy
Sarcoidosis
Honking