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.