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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
Acute (<3 weeks
breathlessness, fatigue, after URTI, respi infection, TB, LPR, phonotrauma, exposure to environmental irritants / noxious agents.
cervical lymphadenopathy
Chronic
Toxins
Laryngopharyngeal reflux (LPR)
Muscle tension dysphonia
Traumatic
Blunt trauma to neck / chest / larynx
Neoplastic
Vocal fold nodules and polyps - benign vocal cord lesion
Vocal fold cyst
Laryngeal papilloma (HPV associated)
Stridor
Vocal cord granulomas
Squamous cell carcinoma of larynx
persistant, progressive, non-fluctuating hoarseness; cough, bloody sputum, referred otalgia (late), cachexia, dyspnoea, dysphagia (late); chronic smoking, alcohol, virus (HPV etc.), family Hx
Head and Neck cancer
Neurologic
Vagus nerve palsy
Recurrent laryngeal nerve palsy
Thyroid malignancy
Bronchial carcinoma
Post-op thoracic, parathyroid, thyroid surgery
esophageal carcinoma
Thoracic aortic aneurysm
Mitral valve stenosis
Spasmodic dysphonia
adductor spasmodic dysphonia
abductor spasmodic dysphonia (less common)
Essential tremor
Multiple sclerosis
Charcot's triad (intention tremor, nystagmus, scanning speech)
Parkinson"s
MG
Fluctuating hoarseness, myopathy, fatigue, dysphagia & stridor (sometimes); females (20-30 YO), family Hx
Ptosis, diplopia
Cerebrovascular accident
Endocrine
Acromegaly
headache, visual field defects (bitemporal hemianopsia), CN palsies, menstrual dysfunction, progressive/sustained hoarseness with thyroid enlargement; insidious onset; usually 40-45 YO
Hypothyroidism
sustained hoarseness, tired, sleepy, lethargic, poor mood, cold-intolerant, weight gain, constipation, menorrhagia; insidious course, women > 40 YO, primary atrophic
bradycardia, hyporeflexia, cerebellar ataxia, dry & thin skin & hair, goitre (some), Reinke’s oedema
Goitre
Hashimoto's - AI disease attacking thyroid
Amyloidosis
progessive dysphonia, dysnea, cough
Inflammatory arthritis (cricoarytenoid joint)
family history
Sarcoidosis
Others
Vocal cord abuse
Reinke's edema (polypoid corditis) - benign vocal cord lesion
LPR, smoking, other irritants
Medications (such as corticosteroids)
fluticasone
Vocal abuse