HOARSENESS

Ask the Following Questions:

1. Is it acute? Acute hoarseness is usually due to a viral URI, but acute simple laryngitis and acute subglottic laryngitis or rarely laryngeal diphtheria may be responsible. Simple strain may be responsible due to the patient's occupation.
2. Is it intermittent? Intermittent hoarseness would suggest myasthenia gravis, urticaria, occupational causes, reflux esophagitis, tobacco, and alcoholism.
3. Are there abnormalities on the neurologic examination? If there are other abnormalities on the neurologic examination, one should consider peripheral neuropathy, poliomyelitis, Guillain-Barré syndrome, brain stem tumors, and cerebrovascular disease.
4. Are there abnormalities on the laryngoscopic examination? Laryngoscopy will identify many intrinsic lesions of the vocal cords such as carcinoma, singer's nodes, polyps, tuberculosis, or syphilis. It will also identify vocal cord paralysis due to carcinoma of the lung, aortic aneurysm, cardiac enlargement, or other mediastinal tumors.

A normal laryngoscopic examination would suggest hysteria, myxedema, or acromegaly.

DIAGNOSTIC WORKUP

Acute hoarseness will require only a CBC, sedimentation rate, nose and throat culture, and sputum culture if sputum is available. A chest x-ray may also be ordered. Laryngoscopic examination is rarely necessary unless the acute hoarseness becomes chronic.

The laryngoscopic examination is the single most important test for chronic hoarseness. It will identify most intrinsic lesions. If vocal cord paralysis is found, a chest x-ray and possibly a CT scan of the mediastinum may be ordered. However, an ear, nose, and throat specialist should be consulted before ordering these expensive tests. If the chords are edematous, hypothyroidism or angioneurotic edema may be the cause. The latter may be excluded by ordering a C1-esterase inhibitor level. If there are other neurologic abnormalities, a referral to a neurologist should be made before ordering a CT scan or MRI of the brain. In cases of intermittent hoarseness, a Tensilon test or acetylcholine receptor antibody titer should be done.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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