Hoarseness

David P. Goldstein B.A., Meds 9T8 University of Toronto

 

Dysphonia is defined as an impairment of voice, and can be divided into two categories; problems with projection of voice or problems with quality of voice. Hoarseness is one form of dysphonia that is defined as a rough or noisy quality of voice. However, hoarseness is often used interchangeably with dysphonia.

 

Importance: hoarseness is a symptom of both local laryngeal pathology and systemic disease. It is not only a distressing symptom for patients, but is also often the early presenting symptom of serious disease such as cancer of the larynx.

Mechanics of voice production

Anatomy: The vocal apparatus of the larynx (the glottis) consists of a pair of true vocal cords that are lengthened, abducted and adducted by numerous muscles, thereby changing the tension of the cords and the amount of space between them. The musculature is innervated by 2 branches of the vagus nerve, the superior laryngeal and the recurrent laryngeal nerves (dominant supply).

 

Voice production: During speech a column of air is passed through the adducted vocal cords, causing them to vibrate and produce sound that is shaped into articulated speech with the help of the oropharynx, tongue and lips. Any changes in the vocal cord or controlling structures may result in abnormal voice production by interfering with cord movement, approximation or vibration (organic dysphonia). On the other hand dysphonia may still be present with normal anatomy (functional dysphonia).

 

Differential Diagnosis

See Table 1 for the most common clinical entities

Organic

Infectious Inflammatory

Non-infectious inflammatory (chronic irritation leading to vocal edema, nodules, contact ulcers or chronic laryngitis)

Trauma- external laryngeal trauma

Neoplasia

Systemic

Neurologic

Functional

Psychogenic aphonia ( hysterical aphonia)

Habitual aphonia

Ventricular dysphonias

Diagnosis:

History: take a full history keeping in mind the differential diagnosis to guide your questions

 

Physical

References

Berke G, Kevorkian K. The Diagnosis and Management of Hoarseness. Comprehensive Therapy. 1996; 22(4): 251-255,

Dettelbach M, Eibling D, Johnson J. Hoarseness: From viral laryngitis to glottic cancer. Postgraduate Medicine. 1994; 95(5): 143-163

Garrett C, Ossoff R. Hoarseness: Contemporary Diagnosis and Management. Comprehensive Therapy. 1995; 21(12): 705-710

Meyerhoff W L, Rice DH. Otolaryngology- Head and Neck Surgery. Philadelphia, Pa: W.B. Saunders; 1992.