Hoarseness

• dysphonia (1)
  • is an abnormality in voice quality
  • is also described as hoarseness .
• the patient may describe loss of voice quality in many different ways
  • the voice quality that may be described and their differential diagnosis are as follows:
    • breathy
      • vocal cord paralysis, abductor spasmodic dysphonia, functional dysphonia
    • hoarse
      • vocal cord lesion, muscle tension dysphonia, reflux laryngitis
    • strained
      • adductor spasmodic dysphonia, muscle tension dysphonia, reflux laryngitis
    • low-pitched
      • Reinke's oedema, vocal abuse, reflux laryngitis, vocal cord paralysis, muscle tension dysphonia
    • tremorous
      • Parkinson's disease, essential tremor of the head and neck, spasmodic dysphonia, muscle tension dysphonia
    • vocal fatigue
      • muscle tension dysphonia, vocal cord paralysis, reflux laryngitis, vocal abuse
• in most cases, hoarseness is a relatively benign symptom of voice overuse or the result of laryngitis.
• however, hoarseness that persists for more than three weeks must be considered to be a laryngeal carcinoma until proven otherwise, and requires an urgent referral to an ENT department.
• the causes of hoarseness include (1)
  • neoplastic
    • vocal cord polyps, vocal cord nodules, vocal cord granulomas, vocal cord cyst, laryngeal papilloma, squamous cell cancer of the larynx
  • inflammatory
    • gastroesophageal reflux laryngitis, viral laryngitis, bacterial laryngitis, tubercular or fungal laryngitis,allergic laryngitis
  • neurologic
    • vocal cord paralysis (unilateral),spasmodic dysphonia,movement disorder (Parkinson's disease),essential tremor,cerebrovascular accident
  • miscellaneous
    • vocal abuse, vocal cord atrophy, vocal cord scarring, hypothyroidism (myxedematous laryngitis), muscle tension dysphonia, Reinke's oedema,drugs
      
      

Reference:

(1) Rosen CA et al. Evaluating Hoarseness: Keeping Your Patient's Voice Healthy. American Family Physicia 1998; 57(11)