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Hoarseness

last modified on: Tue, 12/19/2017 - 10:59

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Overview:
  • Hoarseness is ideally defined as abnormal vocal cord vibration
  • Any change in voice quality is often referred to as hoarseness
  • Many etiologies from many anatomic locations- oral cavity to lungs
  • Can be broken up into acute vs chronic hoarseness
    • If persists longer than 3 weeks, patient should be referred to an otolaryngologist 
  • Hoarseness is a symptom or sign- not a diagnosis

Unknown Author [Vocal cord tumor interfering with voice production], via Wikimedia Commons

Common Etiologies:
  • Viral URI:
    • most common cause
    • swelling of the vocal cords
    • acute, often can last up to several weeks 
    • treatment consists of conservative management and supportive therapies including voice rest
  • Laryngopharyngeal reflux:
    • Extraesophageal reflux disease
    • Symptoms:
      • Morning hoarseness
      • Throat clearing
      • Persistent sore throat
      • Nocturnal cough
      • Globus sensation
    • Erythema and thickening of laryngeal mucosa
    • Treatment (similar to GERD):
      • Lifestyle: weight loss, dietary changes
      • Meds: PPIs and H2 blockers
      • Surgery: Nissen fundoplication if resistant to medication
  • Vocal cord nodules/polyps:
    • Benign growths on vocal cords
    • Etiology:
      • Due to chronic inflammation:
        • Vocal abuse
        • Smoking
        • Reflux
      • Affect complete closure of vocal cords 
    • Polyps:
      • More common in men
      • Anterior 1/3 of vocal cords
      • Unilateral
    • Nodules
      • More common in women/children
      • More often due to vocal abuse
      • Often bilateral and symmetric
    • Treatment:
      • Treat underlying etiology
      • Voice rest
      • Surgical removal:
        • Scalpel/scissors
        • CO2 lasers
      • Speech Therapy, Voice Rehab
  • Vocal cord paralysis:
    •  Etiology:
      • Compression of recurrent laryngeal nerve
      • Trauma- intubation
      • Neurological disease
        • Spasmodic dysphonia
        • Parkinson's disease
        • Tremor
        • Myasthenia Gravis 
      • Viral infection
      • Idiopathic
    • Diagnosis:
      • Visualization of vocal cords via laryngoscopy
      • EMG of laryngeal muscles
    • Treatment:
      • Dependent on etiology
  • Reinke's Edema
    • "Chronic hypertrophic laryngitis"
    •  Etiology
      • Chronic edematous changes in Reinke's space
      • Chronic vocal abuse
      • Smoking
    • Treatment
      • Smoking cessation
      • Voice rest
      • Speech therapy
      • Surgery- incise mucosal layer, extravasating fluid from Reinke's space
Suggested Reading:
  • American Academy of Otolaryngology–Head and Neck Surgery Foundation. (2011). Primary Care Otolaryngology, Third Edition. Retrieved from: www.entnet.org
  • Bruch, JM, Kamani, DV. Hoarseness in adults. In: UpToDate, Deschler, DG. (Ed), UpToDate, Waltham, MA. (Accessed on August 5, 2015.)