Week 6: Clinical Problem of a Hoarse Voice. Hoarseness results from imperfect phonation due to impairment of normal vocal cord mobility or vibration. It is an important symptom as it may signal a serious cause such as malignancy or a disease with potential for airway obstruction. Presentation.
Hoarseness results from imperfect phonation due to impairment of normal vocal cord mobility or vibration. It is an important symptom as it may signal a serious cause such as malignancy or a disease with potential for airway obstruction
So , you call the next patient into your room and as soon as she starts speaking to introduce herself, you notice she has a hoarse voice.
Without any further info and before taking a history. What is the most probable diagnoses?????
Viral URTI: acute laryngitis
Non-specific irritative laryngitis
Vocal abuse (shouting, screaming etc.)
Nodules and polyps of cords
Phonaesthenia in elderly - ‘tired’ voice
In acute hoarseness the diagnosis is usually obvious from the history alone.
You ask Mrs X what you can do for her today, and she replies in a hoarse voice “I just came in to get a script for the OCP.” You are concerned by her voice, and are determined to find out more about it. WHAT DO YOU WANT TO ASK IN THE HISTORY TO HELP DETERMINE A DIAGNOSES??
Important to ask:
The patient is vague and dismissive throughout the history, insisting she only came in to get the script and must get back to work. She eventually agrees to an examination. What are you going to do in the examination?
Having finished the examination, you quickly think to yourself- so now what are some things I don’t want to have missed??
Carcinoma: larynx, lung including laryngeal nerve palsy
Imminent airway obstruction (e.g. acute epiglottitis, croup)
Other rare severe infections (e.g. tuberculosis, diphtheria)
Motor neurone disease
RED flag for underlying malignancy, (when not associated with an UTRI)
shortness of breath
What particular investigations are you going to do?
The following need to be considered:
REFER to ENT
- drugs: antipsychotics, anabolic steroids
- smoking →non-specific laryngitis
Is the patient trying to tell me something?
Rarely, hoarseness can be a functional or deliberate symptom referred to as ‘hysterical aphonia’. In this condition, patients purposely hold the cords apart while speaking.