Dysphonia

Dysphonia
ICD-10	R49
ICD-9	784.49

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List of terms related to Dysphonia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: hoarseness

Overview

Dysphonia is the medical term for hoarseness or other phonation disorders. It is considered much less severe than aphonia. Hoarseness can be a change in pitch, a rough sound of the voice, or an increased effort in speaking.

Classificaiton of Dysphonia

Based Upon Chronicity

• Acute hoarseness has a sudden onset and lasts fewer than 2 weeks
• Chronic hoarseness lasts longer than 2 weeks

Based Upon Pathophysiology

• Organic dysphonia
• Functional dysphonia
• Spasmodic dysphonia

Causes

Causes in Alphabetical Order

10th cranial nerve disorder 12th cranial nerve disorder Acoustic neuroma Acute viral laryngitis Aging Allergic rhinitis Amyloidosis Amyotrophic lateral sclerosis Anaphylaxis Aortic aneurysm Aortic dissection Axitinib Bacterial tracheitis / laryngitis Bronchial carcinoma Bronchogenic tumor Bulbar palsy Cerebral palsy Cerebrovascular accident Chondromas Chorditis Chronic cough, severe cold Chronic inhalation of chemical irritant agents (professional activity) Chronic sinusitis Croup Danazol Deep space face and neck infection Diastrophic dwarfism Diffuse idiopathic skeletal hyperostosis Distal myopathy 2 Dornase alfa Edema of vocal cords Elongated styloid process Epiglottitis Esophageal tumor Excessively dry and warm room coupled with low water intake Foreign body in respiratory tract Gastroesophageal Reflux Disease (GERD) Gestrinone Glomus jugulare tumor Goitre Growth hormone secreting pituitary adenoma Guillain-Barre syndrome Habitual aphonia Head injury Hemangioma Hemorrhage into vocal folds Hypothyroidism Juvenile dermatomyositis Laryngeal carcinoma Laryngeal granuloma Laryngeal nerve palsy Laryngeal papillomatosis Laryngitis

Laryngocelesventricular prolapse Laryngomalacia Laryngotracheobronchitis Left atrial enlargement Lipoid proteinosis Lipoma Lung cancer Menopause Motor neuron disease Multiple sclerosis Muscular dystrophy Myasthenia gravis Nasal polyps Neural tumor Neurofibroma Oral submucous fibrosis Oropharyngeal cancer Overstress of vocal cords (speaking, shouting, singing, crying) Papillomas Paracoccidioidomycosis Parathyroid carcinoma Parkinson's disease Polymyositis Posterior inferior cerebellar artery syndrome Postsurgical Psychogenic aphonia Puberty Quinsy Reinke's edema Retention cysts Rheumatoid arthritis Rheumatoid disease Riedel thyroiditis Sarcoidosis Singer nodes Sinusitis Smoke irritation Spasmodic dysphonia Squamous cell carcinoma Systemic lupus erythematosus Thyroid carcinoma Thyroid tumor Tracheolaryngobronchitis Trauma Upper Respiratory Infection Ventricular dysphonias Virilization Vocal cord nodules Vocal cord paralysis Vocal cord polyps Vocal fold cyst Wegener's Granulotomosis

In alphabetical order.

Acute

• Acute viral laryngitis
• Aortic aneurysm
• Aortic dissection
• Anaphylaxis
• Bacterial tracheitis / laryngitis
• Cerebrovascular accident (CVA)
• Chorditis
• Croup
• Deep space face and neck infection
• Epiglottitis
• Foreign body
• Head injury
• Laryngitis
• Laryngotracheobronchitis
• Overstress of vocal cords (speaking, shouting, singing, crying)
• Sinusitis
• Smoke irritation
• Surgery
• Trauma
• Upper Respiratory Infection

Chronic

• Aging
• Allergic Rhinitis
• Amyloidosis
• Amyotrophic Lateral Sclerosis
• Aortic aneurysm
• Bronchial carcinoma
• Bronchogenic tumor
• Chondromas
• Chronic cough, severe cold
• Chronic inhalation of chemical irritant agents (professional activity)
• Chronic sinusitis
• Drugs
• Edema of vocal cords
• Esophageal tumor
• Excessively dry and warm room coupled with low water intake
• Foreign body
• Gastroesophageal Reflux Disease (GERD)
• Glomus jugulare tumor
• Guillain-Barre Syndrome
• Habitual aphonia
• Hemangioma
• Hemorrhage into vocal folds
• Hypothyroidism
• Juvenile dermatomyositis
• Laryngeal papillomatosis
• Laryngocelesventricular prolapse
• Laryngeal carcinoma
• Left atrial enlargement
• Lipoma
• Lung cancer
• Menopause
• Multiple Sclerosis
• Muscular Dystrophy
• Myasthenia Gravis
• Neural tumor
• Neurofibroma
• Papillomas
• Parkinson's Disease
• Postsurgical
• Psychogenic aphonia
• Puberty
• Reinke's Edema
• Retention cysts
• Rheumatoid Arthritis
• Sarcoidosis
• Spastic dysphonia
• Squamous Cell Carcinoma
• Systemic Lupus Erythematosus
• Thyroid tumor
• Ventricular dysphonias
• Virilization
• Vocal cord nodules
• Vocal fold cyst
• Vocal cord paralysis
• Vocal cord polyps
• Wegener's Granulotomosis

History and Symptoms

The following should be characterized as part of a full history:

• Onset
• Duration
• Prior history
• Exposure
• Medications
• Voice use
• Associated symptoms
• Medical history
• Surgical history
• Trauma

Physical Examination

• Focus on neck, head, lung, thyroid and cardiac exams
• Evaluate voice quality

Laboratory Findings

• Thyroid function tests to rule out hypothyroidism

X-Ray

• Chest X-ray
• Lateral neck X-ray

MRI and CT

• CT scan of sinuses
• CT scan of head and neck

Other Diagnostic Studies

• Upper gastrointestinal (GI) endoscopy
• Direct or fiber optic nasolaryngoscopy
• Biopsy

Treatment

• Airway, breathing and circulation
• Voice rest
• Diet modification (GERD)
• Stop smoking
• Wear protective clothing or masks (if hoarseness is due to exposure)
• Treat underlying etiologies
• Voice therapy

Pharmacotherapy

Acute Pharmacotherapies

• Antibiotics
• Oral steroids
• H2 blocker
• Proton pump inhibitors
• Intranasal steroids
• Antihistamines

Surgery and Device Based Therapy

• Surgical intervention for abscesses, masses
• Cricothyrotomy or tracheostomy (to establish airway)

References

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