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hoarseness

Etiology: 1) laryngitis (also see laryngitis) 2) neoplasm a) squamous cell carcinoma 1] head & neck cancer 2] associated with alcohol & tobacco b) benign neoplasm on the vocal cord c) laryngeal wart d) esophageal cancer with recurrent laryngeal nerve involvement 3) gastroesophageal reflux (GERD) 4) sinusitis with a purulent post nasal drip 5) pulmonary hypertension 6) hypothyroidism 7) relapsing polychondritis 8) anaphylaxis 9) leprosy 10) Wallenberg's syndrome 11) vocal cord dysfunction - overuse of the voice 12) pharmaceutical agents a) metered dose inhalers 1] inhaled steroids 2] inhaled beta-2 adrenergic agonists 3] inhaled ipratropium (Atrovent) b) cromolyn c) dornase alfa d) procarbazine 13) temporal arteritis 14) pemphigus vulgaris 15) periodontal disease 16) polycythemia History: 1) duration of symptoms (most important) 2) alcohol & tobacco 3) history of GERD 4) asthma (inhalers) Clinical manifestations: 1) acute onset - infection, overuse 2) chronic - malignancy 3) dysphonia Special laboratory: - laryngoscopy, or refer ENT, when dysphonia fails to resolve or improve within 4 weeks [4,5] Radiology: - computed tomography or MRI not indicated prior to laryngoscopy Management: 1) treat underlying cause - do not treat for GERD prior to laryngoscopy - do not treat with antibiotics - botulinum toxin injections for spasmodic dysphonia or laryngeal dystonia - surgery for malignancy, symptomatic benign vocal cord lesions [4,5] 2) voice therapy [3]

Related

vocal cord dysfunction; inducible laryngeal obstruction

General

dysphonia

References

  1. Kaiser Permanente Clinical Practice Guidelines
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  3. MacKenzie K, Millar A, Wilson JA, Sellars C, Deary IJ. Is voice therapy an effective treatment for dysphonia? A randomised controlled trial. BMJ. 2001 Sep 22;323(7314):658-61. PMID: 11566828 Free PMC Article
  4. Stachler RJ, Francis DO, Schwartz SR et al Clinical Practice Guideline: Hoarseness (Dysphonia) (Update). Otolaryngol Head Neck Surg. 2018 Mar;158(1_suppl):S1-S42. PMID: 29494321 http://journals.sagepub.com/doi/full/10.1177/0194599817751030 - Stachler RJ, Francis DO, Schwartz SR Clinical Practice Guideline: Hoarseness (Dysphonia) (Update) Executive Summary. Otolaryngol Head Neck Surg. 2018 Mar;158(3):409-426. PMID: 29494316
  5. Phillips D. Guideline Updates Recommendations for Persistent Hoarseness. Medscape Medical News. WebMD Inc. March 6, 2018. https://www.medscape.com/viewarticle/893459
  6. Syed I, Daniels E, Bleach NR. Hoarse voice in adults: an evidence-based approach to the 12 minute consultation. Clin Otolaryngol. 2009 Feb;34(1):54-8. PMID: 19260886 Review.
  7. Reiter R, Hoffmann TK, Pickhard A, Brosch S. Hoarseness-causes and treatments. Dtsch Arztebl Int. 2015 May 8;112(19):329-37. PMID: 26043420 PMCID: PMC4458789 Free PMC article. Review.