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Hoarseness for 3 wk female 53 yo (Neurological / Muscular Causes…
Hoarseness for 3 wk
female 53 yo
Laryngeal causes
Acute Infective Picture
Acute Laryngitis
hoarseness, loss of voice, odynophagia (improve with rest and < 3 wks)
URTI, irritant inhalation (smoke), acute vocal strain (rthinitis & sinusitis)
Adjacent Infection
peritonsillar abscess, hot potato voice (muffled thickened), throat pain, odynophagia, trismus, pyrexia
Chronic Inflammation
Chronic Laryngitis
hoarseness, throat clearing, persistent cough, dyspepsia
irritant inhalation, GERD, laryngopharyngeal reflux, allergies or vocal abuse
Vocal Cord Nodules (singer's nodules)
fluctuates, imrpove on weekends, young pts
Vocal Cord Polyps, Cysts
similar to vocal cord nodules,
does not improve on speech therapy (dxg via nasoendoscopy)
Reinke's edema (polypoid corditis)
submuscosal edema
vocal cord abuse, chronic smoke, reflux, hypothyroidism
Neoplastic
Laryngeal cancer
persistent, progressive, non-fluctuting, cough, blood-stained sputum, otalgia, lymphadenopathy, cachexia, dyspnoea, dysphagia
chronic smoking / alcohol
Benign neoplasms
laryngeal papillomatosis (HPV associated)
Neurological / Muscular Causes
Central
UMN: medullary infarct
Parkinson's dx: hypophonic monotone, tremor, hypomimia
Recurrent Laryngeal Nerve damage
Malignancy (unilateral)
lung (mediastinal / apical) or thyroid
cough, haemoptysis, weight loss, palate for thyroid nodules
Iatrogenic
injury, surgery on thyroid, thorax, carotid or C-spine
Aneurysm of aortic arch
NMJ - myasthenia gravis
fluctuating, fatigable hoarseness, dyshagia, stridor
Other nerve pathology
Multiple sclerosis
Guillainbarre syn
Demyelinating dx
Other muscle pathology
Muscle tension dystonia
Spasmodic dysphonia
Other Causes
Idiopathic: 1/3 cases possibly viral in etiology
Voice deteriorates twds end of day:
muscle tension dysphonia, glottic insufficiency
Spasmodic Dysphonia
Voice worse on phone / public speaking
Autoimmune / Rheumatological disease