Wednesday, April 26, 2017

Approach To A Patient Presenting With Hoarseness

Definition Of Hoarseness

Hoarseness is a change in the pitch or quality of the voice caused by abnormalities of vocal cords.


Local Causes:
  • URTI ( most common cause )
  • Laryngitis
  • Trauma to the vocal cords: shouting, coughing, vomiting, instrumentation.
  • Hypothyroidism
  • Acromegaly
  • Chronic acid reflux
  • Allergies
  • Heavy smoking or drinking or both
  • Carcinoma
Neurological Causes:
  • Laryngeal nerve palsy
  • Motor neuron disease
  • Myasthenia gravis
  • Multiple sclerosis
Muscular Causes:
  • Muscular dystrophy
Functional Cause.

  • Sometimes no definitive organic cause can be identified and it might be due to psychological causes.
  • Throat culture
  • Examination of throat with a small mirror
  • Laryngoscopy
  • X-ray and CT of Neck.
Differential Diagnosis

1. Laryngitis: 
  • hoarseness, malaise with or without fever and/ or pain on using voice.
  • Usually viral. Can be caused by bacterial infections.
Management: advice patients to give rest to voice. Analgesics, Anti- biotics in case of bacterial infection.

2. Vocal Cord Nodules: 
  • Usually caused by overuse of vocal cords. 
  • Typically found in singers. 
  • Visualized by laryngoscopy.
Management: Initial treatment is rest to vocal cords but may need surgical excision.

3. Functional Disorders: 
  • More common in females. 
  • Caused by hysterical paralysis of vocal cord adductors due to severe psychological stress. 
  • Can cause the voice to be reduced to a whisper or to be lost completely.
Management: Patients need to be referred for laryngoscopy to rule out organic cause. Speech therapy and psychological support may help.

4. Laryngeal Carcinoma: 
  • More common in males. 
  • Smoking is the major risk factor. 
  • Presents with hoarseness which is followed by stridor, dysphagia and pain.
Management: Urgent referral to ENT. Diagnosis is confirmed by laryngoscopy and biopsy. Treatment is surgery and radiotherapy.

No comments:

Post a Comment