Voice History Flashcards
Key questions to ask in history
Age - malignancy increases with age
Occupation, hobbies - professional voice users (singers, teachers), football matches
Smoking/alcohol - increased malignancy risk
Onset - gradual vs gradual
Duration
-unexplained hoarse voice 3+wks => 2ww
Persistence - constant vs intermittent, triggers
Associated symptoms -
- RED FLAGS - dysphagia, weight loss, referred ear pain
- acid reflux, sinonasal chest disease
Past surgery, radiotherapy?
Examination of larynx
Direct ENT examination
- oral cavity - ill-fitting dentures, other reasons for dysphagia?
- oropharynx - candida?
- nasal cavity - mucus?
- neck nodes - LN
- thyroid gland - masses can affect recurrent laryngeal nerve
- voice quality - rough, breathy, strained?
Indirect
Flexible nasolaryngoscopy
Rigid videostroboscopy
-can record phonatory cycle
Differentials for a hoarse voice
Infective
-acute laryngitis (bacterial , viral, fungal)
Inflammatory
- GORD, laryngopharyngeal reflux
- chronic cough
- post nasal drip
- airbourne irritants (smoking, pollution)
- AI
Neoplastic
- laryngeal/thyroid/lung calcinoma
- lymphoma
Vascular
- thoracic aortic aneurysm
- AVM
Congenital
-vocal cord palsy
Idiopathic
- age-related
- vocal cord palsy
- vocal cord nodules/polyps
- functional dysphonia
Iatrogenic
- thyroid/parathyroid surgery
- neck dissection
- cardiothoracic surgery
- tracheal intubations
Neurological
- CVA
- PD
- MND
Endocrine
-hypothyroidism
Vocal cord palsy
- causes
- investigations
- management
Most common - malignant
Next common - iatrogenic from surgery
Others - ext trauma, idiopathic
CT from skull base => aortic arch
- Can be self limiting
- Vocal fold medialisation - injection or thyroplasty
- Laryngeal renervation
Laryngitis
- acute
- chronic
- management for both
Acute
- URTI Hx
- short duration
- aphonia, sore throat
Management
- voice rest, hydration, humidification
- ABx if needed
Chronic
- persistent dysphonia
- GORD, airbourne irritants, sinonasal disease association
Management
- voice hygiene
- treat underlying cause
- rule out malignancy
Benign laryngeal lesions
-Reinke’s
Reinke’s - bilateral swelling of lamina propria layer => deep masculine voice
-SMOKING and GORD!
Management
- smoking cessation and antireflux meds
- preop SALT
- surgery
Benign laryngeal nodules
Bilateral fibrovascular tissue callouses secondary to vocal abuse/inappropriate vocal use
Management
- SALT
- surgery as last resort
Benign laryngeal polyps
The result of trauma to lamina propria => polyp formation
-can damage opposite vocal cord
Management
-removal via microlaryngoscopy
Papillomatosis
HPV 6, 11 with high recurrence rate
-HPV vaccine will protect against this
Management
-surgical treatment + adjuvant antiviral
Laryngeal carcinoma
- risk factors
- presentation
Older males who smoke and drink
HPV
FHx
Hoarse
Cough
Referred otalgia
Stridor
