Hoarseness

Dysphonia
ICD-10	R49
ICD-9	784.49

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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.

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

Classificaiton of Dysphonia

• Organic dysphonia
• Functional dysphonia
• Spasmodic dysphonia

Differential Diagnosis

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)

See also

• Dysphasia

External links

• VoiceInfo.org
• Pediatric ENT
• WrongDiagnosis
• Marshall
• NetDoctor
• [3]
• Systems Analysis, Modelling and Prediction Group, University of Oxford develops novel signal analysis techniques for the detection and characterisation of voice disorders.