hoarsneess Flashcards
what is hoarseness defined as ?
any change in the quality of human voice
what are the general causes associated with hoarseness ?
congenital
inflammatory
mucosal fold disorders
neoplastic
premalignant
neurological
miscellaneous
endocrine
aging
what are the congenital causes of hoarseness ?
laryngeal webs
vocal cord paralysis
what is the pathology in laryngeal webs ?
incomplete canalization of the laryngeal lumen
what is the clinical picture associated with laryngeal wbs ?
asymptomatic or weak hoarse cry
stridor if the web is large in size
what is the treatment for laryngeal webs ?
no treatment required if asymptomatic
microlaryngeal surgery
tracheostomy if the airway is compromised
what are the inflammatory causes of hoarseness ?
acute laryngitis
croup
chronic non specific laryngitis
chronic specific laryngitis
acute epiglottitis
which of the inflammatory causes of hoarseness is the commonest ?
acute laryngitis
what are the causes of acute laryngitis ?
post upper respiratory tract infection
viral causes include: parainfluenza, influenza, rhinovirus
bacterial causes : strep pneumonia
what is the clinical picture of acute laryngitis ?
general manifestation : fever, headache and malaise
hoarseness
discomfort and pain on phonation
dry cough
mucopurulent discharge
difficulty in breathing in severe cases
what is the treatment for acute laryngitis ?
humidification
rest
pain management
mucolytics
antibiotics
what is the presentation of acute epiglottitis ?
general manifestations - ill
muffled hot potato voice
rapid progressive stridor
what is the management for acute epiglottitis ?
as acute laryngitis
along with proper airway management
why is acute epiglottitis not commonly seen anymore ?
due to Hib vaccine
what is the presentation of croup ?
seal like barking cough
what is the causative organism in croup ?
parainfluenza virus
what is the presentation of chronic nonspecific laryngitis ?
GERD due to chronic irritation
heartburn
globus sensation
regurgitation
night breakthrough
what are the mucosal fold disorders causing hoarseness ?
vocal cord nodules or singers nodules
vocal cord polyps
vocal cord cysts
Reinke’s oedema
what is the gross picture of vocal cord nodules ?
sessile nodules
medial edge of vocal cord
at the junction of ant 1/3 and post 2/3
pinkish in early stage - white in late stage
what is the pathology behind vocal cord nodules ?
epithelial hyperplasia
what is the treatment for vocal cord nodules ?
excision by microlaryngeal surgery
along with voice therapy
where are vocal cord polyps found ?
medial edge or undersurface of vocal cords
at the junction of ant 1/3 and post 2/3
what is the pathology in vocal cord polyps ?
localized subepithelial oedema with vascular engorgement
what is the treatment for vocal cord polyps ?
excision by microlaryngeal surgery
along with voice therapy
what is reinke’s space ?
superficial lamina propria of the vocal ligament
a potential space
how does reinke’s oedema happen ?
accumulation of fluid due to chronic irritation
what is the main cause of reinke’s oedema ?
irreversible swelling of the vocal cords mainly due to chronic heavy smoking
what are the benign neoplastic causes of hoarseness ?
Recurrent respiratory papillomatosis
what is the causative organism of Recurrent Respiratory papillomatosis ?
Human papillomavirus
what is the treatment of recurrent respiratory papillomatosis ?
CO2 ablation
high incidence of recurrence
what are the premalignant causes of hoarseness ?
leukoplakia
what is the pathology behind leukoplakia ?
epithelial hyperplasia and hyperkeratinization due to chronic irritation
what is the presentation of leukoplakia ?
whitish patch with irregular surface
may occur as a single or multiple patches
unilateral or bilateral affection
what is the treatment for leukoplakia ?
excision by microlaryngeal surgery
strict follow up
what are the malignant causes of hoarseness ?
laryngeal carcinoma ( sq cell carcinoma )
what aree the neurological causes of hoarsness ?
bilateral vocal cord paralysis
what is the presentation of bilateral vocal cord paralysis ?
weak breathy voice
what are the causes of bilateral vocal cord paralysis ?
thyroid surgery
trauma
mediastinal mass
which nerves are more likely to be affected in thyroid surgery and in mediastinal masses ?
thyroid surgery : recurrent laryngeal surgery
Mediastinal mass : left vocal cord paralysis
what is the diagnosis of a patient that complains of dysphonia without any obvious anatomical, neurological or other organic causes affecting the larynx ?
muscle tension dysphonia or functional dysphonia
what are the types of functional dysphonia ?
hypofunctional dysphonia - incomplete closure of the vocal cords
hyperfunctional dysphonia - overuse of the laryngeal muscles and occasionally use of the false vocal cords
what is the treatment of muscle tension dysphonia ?
voice therapy
what are the endocrine causes of dysphonia ?
hypothyroidism
hormonal disturbances
dysphonia due to aging ?
presbylaryngis or
presbyphonia
what are the red flags that come with hoarseness ?
history of smoking or alcohol use
concomitant neck mass
unexplained weight loss
accompanying neurological symptoms
accompanying haemoptysis, dysphagia,odynophagia,otalgia
hoarseness that is persistent or worsening
what investigations can be performed for a case of hoarseness ?
flexible nasoendoscopic examination of the larynx
appropriate blood tests
CT scan of the neck +/- mediastinal masses
misuse of voice can lead to -
vocal cord polyps
nodules
or cysts
excessive smoking can lead to ?
leukoplakia
Reinke’s oedema
laryngeal cancer
what endocrinal disorder is associated with reinke’s oedema ?
hypothyroidism
what does it mean when the vocal cord is in a paramedian position ?
recurrent laryngeal nerve paralysis
what are the red flags associated with hoarseness that require urgent ENT referral ?
cachexia
hemoptysis , dysphagia
weight loss
persistent hoarseness for more than 3 weeks
accompanying neurological symptoms
neck mass
