Podcast
Questions and Answers
Which of the following is a direct cause of hoarseness related to physical trauma?
Which of the following is a direct cause of hoarseness related to physical trauma?
Which systemic disease is NOT commonly associated with hoarseness?
Which systemic disease is NOT commonly associated with hoarseness?
What is the first step in the evaluation of a patient presenting with hoarseness?
What is the first step in the evaluation of a patient presenting with hoarseness?
Which medication class is most likely to contribute to voice problems when used in therapy?
Which medication class is most likely to contribute to voice problems when used in therapy?
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Which of the following assessments will NOT typically be part of an ENT examination for hoarseness?
Which of the following assessments will NOT typically be part of an ENT examination for hoarseness?
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What does 'muscle tension dysphonia' refer to?
What does 'muscle tension dysphonia' refer to?
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Which symptom would be least relevant when assessing a hoarse patient?
Which symptom would be least relevant when assessing a hoarse patient?
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Which type of laryngeal lesion is associated with benign vocal cord growths?
Which type of laryngeal lesion is associated with benign vocal cord growths?
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Study Notes
Hoarseness
- Hoarseness is a symptom, not a diagnosis.
- A synonym for hoarseness is dysphonia.
Anatomy
- The larynx contains various structures, including the hyoid bone, epiglottis, and thyroid cartilage.
- The vocal folds are also key components of the larynx's anatomy.
- Laryngeal nerves, such as the superior and inferior laryngeal nerves, play a role in its function.
Causes of Hoarseness
- Inflammatory or Irritant Causes: Allergies, tobacco, alcohol, direct trauma (intubation), environmental irritants, laryngopharyngeal reflux, voice abuse, and medications.
- Laryngeal Lesions or Neoplasms: Benign vocal cord lesions (nodules, polyps), laryngeal papillomatosis, dysplasia, and laryngeal cancer (squamous cell carcinoma).
- Neuromuscular Causes: Nerve injury (vagus, recurrent laryngeal nerve), spasmodic dysphonia, stroke, Parkinson's disease, myasthenia gravis, muscle tension dysphonia, psychogenic causes, and age-related vocal cord atrophy.
- Associated Systemic Disease: Hypothyroidism, rheumatoid arthritis, sarcoidosis, and amyloidosis.
- Medications: Inhaled corticosteroids, angiotensin-converting enzyme inhibitors, antihistamines, diuretics, and anticholinergics.
Clinical Clues for Hoarseness Evaluation
- Vocal Quality: Breathy voice, halting/strangled voice, hoarse/husky/muffled/nasal voice, hoarseness worse early or later in the day, low pitched voice, raspy/harsh/scanning speech, soft voice, strained voice.
- History: Onset (acute or gradual), duration, exacerbating or remitting factors, associated symptoms (cough, dysphagia, heartburn, hemoptysis, history of heavy alcohol or tobacco use.
- Physical Examination: ENT exam, neck exam, chest exam, mirror or fiberoptic laryngoscopy, and video stroboscopy.
Laryngoscopic Findings
- Laryngoscopic findings, such as cysts, exophytic or ulcerative lesions, granulomas, laryngeal inflammation, leukoplakia, loss of vocal fold adduction, nodules, papillomas, polyps, Reinke edema, translucent deposits, ulcerations, and lacerations, can indicate underlying causes of hoarseness.
Diagnostic Tests
- Labs: Thyroid hormones.
- Imaging: Plain X-ray (CXR), lateral neck X-ray, CT scan, MRI.
Treatment
- General: Treat underlying conditions.
- Symptoms: Voice rest, voice hygiene.
- Specific: LPR (PPIs), and surgical intervention (cysts, polyps, nodules, and tumors).
Laryngeal Lesions
- Images related to various laryngeal lesions are presented.
- A total laryngectomy specimen demonstrates a specific surgical procedure.
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Description
Test your knowledge about hoarseness, its symptoms, and the anatomy of the larynx. Learn about various causes, including inflammatory factors, laryngeal lesions, and neuromuscular issues affecting voice quality. This quiz covers essential concepts related to vocal health and laryngeal function.
