Dysphonia/Voice Change

Question 1

Symptom analysis

Answer 1

Open question
Timeline- when did you first notice it, changed over time, come suddenly or gradually, if suddenly, what were you doing at the time

Question 2

Systems review

Answer 2

ENT- hearing, itch, pain, no leak, dysphagia, odynophagia, post nasal drip, bleeding, cough, neck lumps or swellings, nasal obstruction

Gastro- heart burn or indigestion (REMEMBER THIS)

Constitutional- FWARJNLC

Any recent illnesses eg. URTI

Resp (pancoast)- cough, haemoptysis, shoulder pain

Question 3

Patients perspective

Answer 3

Feelings and impact on life

ICE

Question 4

Background information

Answer 4

PMH- happened before, cancer treatment eg, radiotherapy
DH- changes, OTC, allergies, INHALERS
SH- job, home, work with dust or particulates? Use voice a lot at home or work?
FH- anyone in the family had anything similar? Any conditions run in the family

Question 5

Causes of dysphonia

Answer 5

Overuse of voice 
Laryngitis 
Reflux laryngitis 
Reinkes oedema 
SCC larynx 
Spasmodic dysphonia
Lymphadenopathy 
Thyroid disease and lung cancer (if recurrent laryngeal nerve pressed)
Overuse of inhalers eg. Asthma inhalers

Question 6

Neck lumps

Answer 6

Head and neck cancers (not lymphoma) can present as neck lumps
Always consider panendoscopy with biopsy

Question 7

Physiological causes of thyroid swelling

Answer 7

Puberty

Pregnancy

Question 8

Investigations

Answer 8

ENT exam at the bedside
Bloods- FBC UE LFT CRP ESR TFT
Specialist- panendoscopy to view vocal cords