53 years old, woman, persistent hoarseness for past 3 weeks.

structural (vocal folds)

Neoplasm

Laryngeal cancer
(Squamous Cell Carcinoma)

Thyroid cancer

Signs and Symptoms:
Smoking Hx
Alcohol abuse Hx
GERD Hx
Cough
Hemoptysis
Laryngeal Pain
Dysphagia (maybe)
weak, breathy voice
Unexplained weight loss
+ve Cervical LN for mets

Signs and Symptoms:
Neck mass
Unexplained weight loss

Goitre

Hypothyroidism

Infection and Inflammation

Acute Laryngitis
(less likely as > 3 weeks)

Allergy

Signs and Symptoms:
Accompanying sinusitis or rhinitis

Vocal abuse/strain

URI

Laryngopharyngeal reflux Disease

Neurological
(Recurrent laryngeal nerves)

Iatrogenic

Hx of thyroid
/neck
/cardiothoracic
surgery

neoplasm

Mediastinal or Apical
involvement from lung cancer.

Signs and Symptoms:
Family Hx of cancer
Previous Hx of cancer
Smoking Hx, Alcohol Hx
Unexplained weight loss
Hemoptysis

Neurological diseases

Myasthenia Gravis

Parkinson's Disease

Muscle dystonia
(excessive laryngeal or extralaryngeal tension)

  • Neuro and/or psychologic

poor breath control, hard glottal closures,
laryngopharyngeal reflux, and stress.

Spasmodic dysphonia, i.e.. laryngeal
dystonia

focal laryngeal spasm

Multiple Sclerosis

Psychological
(diagnosis of exclusion)

reaction to stress or as a manifestation of
other psychiatric disorder

Conversion Aphonia, the whispered
voice typically remains, but the spoken voice
is lost, often following a traumatic event.

Fluctuating hoarseness,
Worse later in the day
recover with rest

Signs and Symptoms:
Worse later in the day
Intensive practice 3 weeks ago

Uncommon

Sarcoidosis

Amyloidosis

Autoimmune

Rheumatoid Disease
Only when other causes are excluded and other rheumatoid symptoms and signs exists

Laryngeal papillomatosis

Signs and Symptoms:
Worse in the morning
Chronic Cough, Non-productive
Heartburn
GERD Hx
Dysphagia
Frequent throat clearing
globus sensation in throat

Chronic Laryngitis

Signs and Symptoms:
Rhinorrhea
Protracted Cough

Chemical/Toxic fumes

Check:
Occupation Hx
Living environment

GERD Hx

Chronic Sinusitis

Postnasal drip

Chronic alcohol usage

Chronic vocal strain, i.e.. vocal practices

Smoking Hx

LEADING TO BENIGN VOCAL FOLD LESIONS

Signs and Symptoms:
Weak, Breathy voice
Aspiration on consuming thin liquids
Ineffective cough
Loss of swallowing sensation

Stroke

Signs and Symptoms:
Weak, Breathy voice
Aspiration on consuming thin liquids
Ineffective cough
Loss of swallowing sensation
Other focal neurological deficit

  • neurological signs and symptoms

Inhaled corticosteroids usage

Trauma
(Iatrogenic)

Intubation complication

Signs and Symptoms:
halting, strained, strangled voice quality
Voiceless gaps in speech

hypophonic, soft breathy and monotone voice
Resting vocal fold tremor
Other Parkinsons' signs and symptoms

Resting and intentional laryngeal tremors

also present with dyspnea, cough, stridorodynophagia and rarely hemoptysis

Hashimoto's disease:
Gain in weight
Cold intolerance
Constipation
Fatigue
Depression
Myxedema



RED FLAGS

SOB, Stridor, Cough, Hemoptysis, Throat pain, dysphagia, odynophagia and weight loss unassociated to acute respiratory infection

Graves' Disease

Signs and Symptoms:
Pretibial Myxedema
Heat intolerance
Exophthalmos
Diarrhea
Unintentional Loss of Weight
Increase in resting heartrate