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