Hoarseness Flashcards
Causes of hoarseness?
Voice overuse e.g. vocal cord nodules
Smoking
Viral illness e.g. laryngitis
Hypothyroidism
GORD
Laryngeal carcinoma
Lung cancer e.g. small cell
thyroid carcinoma
hypopharyngeal carcinoma
What is the guidelines for who to suspect having laryngeal cancer?
People aged 45 and over with:
Persistent unexplained hoarseness OR unexplained lump in neck
What does head and neck cancer encompass?
Oral cavity cancers
cancers of the pharynx
Cancer of the larynx
Features of head and neck cancers? (90% are squamous cell carcinomas)
Neck lump / pain
Hoarseness >6 weeks
sore throat > 6 weeks
Persistent mouth ulcer (painless)
mouth bleeding
mouth numbness
sore tongue
patches on tongue
earache / effusion
lumps (lip, mouth, gum)
speech change
dysphagia
Oral cancer 2WW referral guidelines?
Unexplained ulceration in oral cavity lasting more than 3 weeks OR persistent and unexplained neck lump
Thryoid cancer 2WW referral guidelines?
Unexplained thyroid lump
Red flags for laryngeal cancer?
Persistent, unilateral, throat discomfort
Dysphagia, odynophagia
Persistent hoarseness
RF for laryngeal cancer?
Tobacco use > 40 pack years
Alcohol use >8 units a day
GORD
achlorhydria
Fhx
Black
Male
Hx of radiotherapy
Features of laryngeal cancer?
Hoarseness
Dysphagia
Odynophagia
Cervical lymphanedopathy
supraglottic or glottic mass
lesional erythroplasia, ulceration, necrosis or bledding
Investigations for laryngeal cancer?
Neck CT with contrast- to check lymphnode mets
Chest CT with contrast- most common site of H&N cancers to metastise to is the lungs
FNA of neck mass- cytological analysis (usually confirms squamous cell carnicoma)
Flexible fibre- optic laryngoscopy- can visualise the larynx- given to pts referred via 2WW
RIsk factors for H&N cancer?
Smoking
chewing tobacco
chewing betel leaf
alcohol
HPV (16)
EBV
Red flags for H&N cancer?
Lump in mouth or lip
Unexplained uclers in mouth lasting more than 3 weeks
Erythroplakia or erythroleukoplakia
Persistent neck lump
Unexplained hoarseness of voice
Unexplained thyroid lump
What staging is used for H&N cancer?
TNM
Management of H&N cancer?
May involve any combo of:
Chemotherapy
Radiotherapy
Surgery
Targeted cancer drugs (i.e., monoclonal antibodies)
Palliative care
What is cetuximab?
Monoclonal ab
Used in treating squamous cell carcinomas of head and neck
May be used in bowel cancer
Targets epidermal growth factor receptor- blocking this activation and inhibiting growthy and mets of the tumour
What is laryngopharyngeal reflux?
Condition caused by GORD resulting in inflammatory changes to the larynx/hypopharynx muscosa
Features of Laryngopharyngeal reflux?
Globus- typically felt in the midline, worse when swallowing saliva rather than eating or drinking
Hoarseness
Chronic cough
Dysphagia
Heartburn
Sore throat
Examination findings in Laryngopharyngeal reflux?
External exam of neck- normal w NO masses
Posterior pharynx may appear erythematous
How do you diagnose Laryngopharyngeal reflux?
Absence of Red flags- clinical diagnosis
If red flag symptoms are present, need to refer via 2WW
Management of laryngopharyngeal reflux?
Lifestyle measures- avoid triggers e.g. fatty foods, caffeine, chocolate, alcohol
PPI
Sodium alginate liquids- Gaviscon
How does lung cancer cause hoarseness?
Pancoast tumour pressing on recurrent laryngeal nerve
What is Reinke’s Oedema
Thickening and enlargement (chronic irritation) of vocal cords causing prolonged and persistent hoarseness caused by smoking +/- chronic voice abuse
Deep, gruff voice i.e. woman (elderly, smoker, hypothyroid say sound like a man)
Associated with hypothyroidism
Treat: supportive, stop smoking, SALT, laser therapy may help
Describe the different pathophysiology for how different H&N cancers can cause hoarseness
Hoarseness = alteration in quality of phonation
Caused by:
- Direct invasion of the larynx by a tumour e.g. laryngeal cancers
- Invasion of recurrent laryngeal nerve -> vocal cord paresis e.g. cancers of the thyroid, oesophagus, apex of lung (i.e. pancoast)
Do oropharyngeal cancers cause hoarseness ?
Oropharyngeal cancers = tongue base and tonsils
DO NOT CAUSE HOARSENESS - they cause a CHANGE in voice, called “ a hot potato” quality in advanced cases.
This is due to the compromised enunciation and altered vocal resonance.
Chronic hoarseness in a patient with a concurrent neck mass and smoking history should be considered ….?
cancer until proven otherwise
always investigate hoarseness (esp in smokers) >6 weeks often the only symptom of larygneal carcinoma
Chronic hoarseness in a patient with a concurrent neck mass and smoking history should be considered ….?
cancer until proven otherwise
always investigate hoarseness (esp in smokers) >6 weeks often the only symptom of larygneal carcinoma
