Dysphonia Flashcards
What are causes of hoarse voice? Risk?
Voice overuse Smoking Viral illness Hypothyroidism GORD Laryngeal cancer Lung cancer
What should you ask about in hoarse voice?
Reflux Dysphagia Smoking Alcohol Stress Singing/shouting Occupation URTI Chest symptoms
What tests in hoarse voice?
Laryngoscopy to assess cord mobility
Inspect the mucosa and exclude local causes
Chest x-ray to exclude apical lung lesions
What is presentation of laryngeal cancer?
Progressive and persistent gruff voice
When should you refer for laryngeal cancer?
Age 45+
Persistent unexplained hoarse voice or
An unexplained lump in neck
What is laryngitis? Management?
Viral inflammation of larynx
Can be secondary staph/strep infection
Can be secondary to GORD or autoimmune disease e.g. RA
Pain, dysphagia, horseless, fever
Supportive management
Phenoxymethylpenicillin if required
What is Laryngopharyngeal reflux? Management?
Chronic laryngeal signs associated with GORD
PPI Diet/lifestyle modifaction Weight loss Less alcohol Do not eat before bed Low fat foods
Surgical fundoplication
What is Reinke’s oedema? Management?
Chronic cord irritation from smoking ± chronic voice abuse that may cause a gelatinous fusiform enlargement of the cords resulting in deep gruff voice.
Hypothyroid, elderly, female smokers
Stop smoking
SALT
What are vocal cord noodles? What is management?
Nodules caused by vocal abuse (poor singing technique, shouting)
Variable husky voice
Fibrous nodules form at the junction of the anterior 1/3 and posterior 2/3 of cords
This is the middle of the membraneous vocal folds - posterior portion of cords is cartilage
SALT
Surgicla excision
What is spasmodic dysphonia? Management?
Focal laryngeal dystonia of unknown cause
Involuntary spasms of the vocal cords produce strained strangled breaks in connected speech
Botox infections into laryngeal muscles
What is muscle tension dysphonia? Management?
Functional disorder due to abnormal laryngeal muscle tension
Patients complain of husky hoarse voice that tires easily
Associated with voice misuse and psychological stress.
Reassurance and explanation ± SALT
What does the recurrent laryngeal nerve supply? Where does it originate from?
Intrinsic muscles of the larynx (apart from cricothyroid muscle)
Responsible for abduction and adduction of the vocal fold.
Orginates from the vagus nerve
What are symptoms of vocal cord paralysis?
Weak, breathy voice with weak cough
Repeated coughing/aspiration
Exertional dyspnoea (narrow glottis reduces air flow) - while at rest, contralateral cord can compensate by increasing abduction
What are causes of RLN palsy?
Cancer - larynx, thyroid, oesophagus, lung
Iatrogenix
CNS disease
Idiopathic
What investigations in RLN palsies?
CXR
CT
US thyroid
OGD
