Hoarseness

Question 1

Causes of hoarseness

Answer 1

• Mucosal lesion
• Paralysis
• Age-related
• Sinister if >6 weeks, progressive
• Risk factors include smoking and alcohol excess
• Ask about Hx of surgery/intubation

Question 2

Age-related voice change (presbyphonia)

Answer 2

• Common cause of hoarse voice (and referrals)
• Bowing of vocal cords due to atrophy
• Incomplete glottic closure

Question 3

Laryngitis

Answer 3

• Common, short lasting acute inflammation
• Affects laryngeal mucosa
• Multiple aetiology - URTI, chemical injury, physical injury
• Spontaneous recovery (voice rest, hydration, steam)
• Chronic/recurrent laryngitis - laryngeal reflux, smoking, alcohol, snoring
• Systemic diseases - RA, sarcoidosis

Question 4

Vocal cord palsy

Answer 4

• Breathy voice
• Cough/choking after swallowing
• Aetiology:
  
  • Iatrogenic - neck surgery (particularly thyroid), cardiothoracic surgery
  • Tumours - head and neck (direct invasion of the larynx and laryngeal nerve)
  • Stroke
  • Neck or chest injury
  • Neurological
  • Viral infections
• Vocal cord may be:
  
  • Abducted - breathier voice by no airway compromise
  • Adducted - potential airway compromise
• Treatment:
  
  • Conservative
    
    • Lung tumour, poor prognosis
  • SALT
  • Cord medialisation procedures to improve voice
  • Cordotomy procedures to improve airway

Question 5

Vocal cord polyp

Answer 5

• Pedunculated or sessile lesions, often unilateral
• Associated with inflammatory changes
• Aetiology:
  
  • Physical - voice abuse, chronic cough
  • Chemical - LPR, smoking, alcohol
  • Infection
  • Allergy/inflammation

Question 6

Vocal cord granuloma

Answer 6

• Caused by continuous damage and subsequent healing processes

Question 7

Recurrent respiratory papillomatosis

Answer 7

• Affects children and adults
• HPV types 6 and 11
• Treatment:
  
  • Endoscopic removal with microdebrider
  • Laser
  • Mitomycin/interferon
• HPV vaccination

Question 8

Reinke’s oedema

Answer 8

• Inflammatory oedema
• Often bilateral
• Aetiology:
  
  • Smoking
  • Severe laryngeal reflux
• Results in deepening of voice
• Treatment - lateral cordotomy (remove fluid) if required, smoking cessation
• Will recurr if patient continues to smoke

Question 9

Vocal cord nodules

Answer 9

• Voice misuse is main culprit
• Soft inflammatory swelling over microhaemorrhage progresses to fibroblasts and collagen fibres
• Treat with SALT

Question 10

Muscle tension dysphonia

Answer 10

• Most common type of functional disorder
• Increased and sustained tension in laryngeal muscles results in abnormal movement of cords
• Usually females
• Other contributing factors:
  
  • Psychological conditions
  • Aging
  • LPR
  • URTI
• MTD diagnosed in absence of other pathology
• Speech therapy and treat any contributing factors

Question 11

Laryngeal cancer

Answer 11

• Majority is squamous cell carcinoma
  
  • Associated with smoking and alcohol
  • Lower socioeconomic groups
  • Subset HPV related
• Cardinal symptoms is hoarseness
• Other symptoms include:
  
  • Dysphagia
  • Weight loss
  • Haemoptysis
  • Neck lump
  • Pain
  • Aspiration
  • Airway compromise
• Investigation:
  
  • Cytology (FNA of cervical lymphadenopathy) or biopsy
  • Imaging - CT/USS/PET
• Management depends on staging but can involve surgery, radiotherapy and chemotherapy