Evaluation of Hoarseness and Stridor

Question 1

What is hoarseness

Answer 1

Change in voice quality characterized by a change in pitch and breathiness

Question 2

What are the Functions of the Larynx

Answer 2

• Protection of the lower airway
• Phonation
• Breathing
• Chest fixation

Question 3

Discuss the aetiology of voice hoarseness

Answer 3

● Congenital:
• Laryngeal webs
• Laryngeal cysts
• Congenital Adductor vocal cord Palsy

● Acquired
• Traumatic: Intubation, caustic aspiration, Laryngotracheal trauma
• Inflammatory/Infections: Acute, chronic, allergic laryngitis
• Neoplastic: Benign polyps, papillomatosis, Malignancies
• Auto-Immune: Wegener’s (Granulomatosis with Polyangitis GPA), Myasthenia gravis
• Metabolic: Hypothyroidism
• Vascular: Ortner’s syndrome (hoarseness due to LT recurrent LN palsy from enlarged cardiovascular structures)

TIV MAN

Question 4

How do you evaluate a patient with hoarseness of voice.

Be detailed in all

Answer 4

• HISTORY
• EXAMINATIONS (General physical, ENT/Neck exam, Laryngoscopy)
• INVESTIGATIONS (x-rays, CT scan, MRI)

NB:- Do a chest exam when investigating for Stridor.

Question 5

What is Stridor

Answer 5

This is noisy breathing resulting from turbulent airflow through the laryngotracheal airway. It can be inspirational, expirational or mixed.

Question 6

List the aetiology of Stridor

Answer 6

● Congenital
• Laryngomalacia
• Laryngeal web
• Subglottic stenosis
• Hemangioma
• Congenital Abductor VC paralysis

ACQUIRED
- Trauma
- Infection/Inflammation
- Neoplasm
- Congenital (already listed)
- Autoimmune/Allergy
- Metabolic (eg Hypothyroidism)
- Vascular (eg Ortner’s syndrome)
- Endocrine (DM)
- Drugs/Degenerative

NB: Some Stridor cases can be emergency cases eg Acute epiglottitis