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53 year old Female Singer 3 week Persistent Hoarseness (NEURO (Muscle…
53 year old Female
Singer
3 week Persistent Hoarseness
INFECTION
Alarm: Cough and Sore Throat, Smoking Use, Acute Onset
Pharyngitis
Symptoms: Fever, Sore Throat, Dysphagia
Viral
Symptoms: Cough, Coryza, Rhinorrhea, Hoarseness
Bacterial
Symptoms: No Cough, Coryza or Rhinorrhea. Has tonsillar eryhthema with or without tonsillar swelling and exudate, fever, lymphadenopathy
Epiglottitis
Symptoms: Fever, Sore Throat, Dysphagia
Signs:
Acute Laryngitis
Hx: URTI, Vocal Strain
Symptoms: Cough
Upper Airway Cough Syndrome
Chronic Laryngitis
Hx: Smoking, Chronic Abuse of Voice, Fluticasone (Inhaled Corticosteroid)
Symptoms: Vocal Cord Damage, Throat Clearing
See: Vocal Cord Myopathy
Laryngeal Papillomatosis
Hx: HPV Infection
Symptom: Airway Obstruction
Sign: Stridor
MALIGNANCY
Alarm: Hemoptysis and Lymphadenopathy, Dysphagia, Heartburn, Chronic Alcohol Use, Smoking, Odynophagia, Airway Obstruction, Weight Loss
Laryngeal Polpys
Hx: Allergies, Tobacco and Irritant Use, Vocal Abuse
Lymphadenopathy - Metastatis from Head/Neck
Symptoms: Dysphagia, Chronic Cough, Hemoptysis
Signs: Palpable Lymph Nodes on the cervical area
Dysplasia
Hx: Alcohol and Tobacco
Squamous Cell Carcinoma
Symptom: Cough, Hemoptysis, Pain and Dysphagia
Sign: Ulcerated Lesions, Exophytic Lesion, Leukoplakia
NEURO
Muscle Tension Dystonia
Hx: Laryngoesophageal Reflux
Symptoms: Poor breath control, Stress
Signs: Hard Glottal Closure
Myasthenia Gravis
Multiple Sclerosis
Injury to Vagus or Recurrent Laryngeal Nerve
Hx: Neck, Thyroid, Cardiothoracic Surgery
Symptom:
Sign: Vocal Cord in Paramedian or Lateralized Position, Unilateral Paralysis
Parkinson's Disease
Psychogenic or Conversion Aphonia
Symptom: Whispering voice without speaking voice
Sign: Loss of vocal cord adduction in phonation but normal in coughing or throat clearing
Spasmodic Dysphonia or Laryngeal Dystonia
Sign: Focal laryngeal spasm
VASCULAR
Verterbrobasilar Insufficiency
Symptoms: Vertigo, Dysphagia, Dysarthria, Balance Problems and Other Cranial Nerve Symptoms
Signs: Cerebellar Ataxia, Sensory and Motor Impairment
SYSTEMIC
Muscular Dystrophy
Symptoms: Dysphagia, Pain when Speaking
Signs:
Paradoxical Vocal Cord Motion Disorder
Symptoms: Stridor
Acromegaly
Amyloidosis
Symptoms:
Signs: Translucent, yellow, waxy deposit on vocal cord
Hypothyroidism
Inflammatory Arthritis involving Cricoarytenoid
Symptom:
Sign: Odynophagia
Sarcoidosis
INFLAMMATORY
Alarm: History of Irritants, Cough, Acute Onset
GERD
Symptoms: Chronic Cough, Dyspepsia
Vocal Cord Myopathy
Hx: Inhaled Corticosteroids
Signs: Granuloma, Throat Clearing
See: Chronic Laryngitis
Allergies
Symptoms: Rhinitis, Sinusitis, Throat Clearing
Irritant: Alcohol/Tobacco
Hx: Laryngitis
Laryngoesophageal Reflux
Hx: Alcohol, Tobacco and Irritant Use
Symptoms: Dysphagia, Heartburn
Signs: Reinke Edema
Vocal Abuse - Acute Onset
Hx: Professional Singer/Untrained Singer
Symptom:
Sign: Granuloma and Cysts and Nodules
Trauma or Intubation
Signs: Granuloma, Ulceration, Laceration