Hoarseness of Voice

Hoarseness of VoiceDefinitionHoarseness is defined as roughness of voice resulting from variations of periodicity and/or intensity of consecutive sound waves.Production of normal voiceVocal cords should:

Be able to approximate properly with each other.Have a proper size and stiffnessHave an ability to vibrate regularly in response to air column.

Conditions causing hoarsenessLoss of approximation as in vocal cord paralysis, fixation, tumor coming in between the vocal cordsSize of the cord which may increase in oedema of the cord or a tumor, or decrease in partial surgical excision or fibrosisStiffness, decreases in paralysis and increases in spastic dysphonia or fibrosis

AetiologyCauses:InflammationAcute- acute laryngitis usually following cold, influenze, exanthematous fever, laryngotracheobronchitis, diphtheriaChronic- Specific: TB, Syphilis, scleroma, fungal infections Non specific: Chronic laryngitis, atrophic laryngitis

2. Tumors- Benign: Papilloma, hemangioma, chondroma, fibroma, leukoplakia Malignant: Carcinoma3. Tumor like masses- Vocal nodule, Vocal polyp, angiofibroma, amyloid tumor, contact ulcer, laryngocoele4. Trauma- Sub mucosal haemorrhage, laryngeal trauma, foreign bodies, intubationPapilloma

Carcinoma Larynx

Vocal Polyp

4. Paralysis- paralysis of recurrent, superior laryngeal or both nerves5. Fixation of cords- Arthritis, fixation of cricoaryetenoid joints6. Congenital- Laryngeal web, cysts, laryngocoele7. Miscellaneous- Dysphonia Plica Ventricularis, Mixoedema, Gout8. Functional- Hysterical aphonia

Laryngocoele

Fixation of cords

Laryngeal web

Investigations1. History Mode of onset, duration of illness, patients occupation, habits and associated complaints.

Any hoarseness persisting for more than 3 weeks deserves examination of larynx. Malignancy should be excluded in patients above 40 years.2. Indirect Laryngoscopy Many of the local laryngeal causes can be diagnosed

3. Examination of neck, chest, cardiovascular and neurological systems for laryngeal paralysisIndirect Laryngoscopy

4. Lab investigations and Radiological examination5. Direct Laryngoscopy and Micro layngoscopy for detailed examination, biopsy of lesions and assessment of mobility of cricoaryetenoid joints6. Bronchoscopy and Oesophagoscopy in cases of paralytic lesions of the cord to exclude malignancy

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