Hoarseness UMST PDF

HOARSENESS DR RAJAB MUGABO  Hoarseness ► Synonyms: Dysphonia ► Hoarseness: symptom not diagnosis Anatomy  Causes ► Inflammatory or irritant ► Laryngeal lesions or neoplasms ► Allergies and irritants (tobacco,...

HOARSENESS DR RAJAB MUGABO  Hoarseness ► Synonyms: Dysphonia ► Hoarseness: symptom not diagnosis Anatomy  Causes ► Inflammatory or irritant ► Laryngeal lesions or neoplasms ► Allergies and irritants (tobacco, ► Benign vocal cord lesions (nodules, alcohol) polyps) ► Direct trauma (intubation) ► Laryngeal papillomatosis ► Environmental irritants ► Dysplasia ► Infectious ► Laryngeal cancer: Squamous cell carcinoma. ► Laryngopharyngeal reflux ► Voice abuse ► Medications  Causes… ► Neuromuscular causes ► Associated systemic disease ► Nerve injury: Vagus, Recurrent ► Hypothyroidism laryngeal nerve injury ► Rheumatoid arthritis ► Spasmodic dysphonia (laryngeal ► Sarcoidosis dystonia) ► Amyloidosis ► Stroke ► Medication ► Parkinson disease ► Inhaled corticosteroids ► Myasthenia gravis ► Angiotensin converting enzyme ► Stroke inhibitors ► Muscle tension dysphonia ► Antihistamines, diuretics, ► Psychogenic anticolinergics ► Age-related vocal cord atrophy Evaluation of hoarseness ► History & physical examination ► First step ► Assessing voice quality, speech effort, signs of pain with speaking or swallowing ► History ► Changes in voice quality ► Timing ► Onset: acute or gradual ► Duration ► Exacerbating or remitting factors ► Associated symptoms ► Voice use ► Smoking/alcohol Examination ► ENT Exam ► Neck exam ► Chest exam ► Mirror or fibreoptic laryngoscopy ► Video Stroboscopy Laryngeal lesions Total laryngectomy specimen Other Diagnostic tests ► Labs: Thyroid hormones ► Plain x-ray: CXR, Lateral neck ► CT Scan ► MRI Treatment ► Treat underlying condition ► Voice rest ► Voice hygiene ► LPR: PPIs ► Surgical intervention: cysts, polyps, nodules, tumors