Return to: Otolaryngology Medical Student Clerkship Objectives and Exam Topics (University of Iowa)

see also: Common Voice Disorders Take Home Points

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

References

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.)