Let's learn about the differential diagnosis of hoarseness of voice and that of vertigo. Additional points on ototoxic drugs.

1. Hoarseness

2. • Inspiration-cords abducts
• Phonation, swallowing- cord adducts
Vocal cord anatomy

3. Differential diagnosis
• Repeated forceful vocal cord adduction with high velocity expiratory
airflow
 Shouting at a football game
 Chronic overuse of voice as in singers
• Interfering vibration of free edges of cord / incomplete closure of glottis
 Benign Vocal cord lesions
• Intramucosal hematoma
• Singer’s nodule
• Polyps/papilloma
• Acute laryngitis
 Malignant vocal cord lesion (vocal cord carcinoma)
 Injury to vagus nerve (recurrent laryngeal nerve)
• Thyroid surgery
• Other neck surgery
• Other
 Smoking (irritates vocal cord mucosa + risk factor for aerodigestive cancer)
 Reflux disease

5. Vertigo

6. Flash quiz
When you nod ‘Yes’ with head, the head motion is
detected by which semicircular canal?
• Lateral
• Posterior
• Superior

7. Superior semicircular canal

8. Posterior semicircular canal

9. Lateral semicircular canal

10. Rotatory (sensation of rotation)
• Episodic (few secs)
 BPPV
 Postural hypotension
 Perilymphatic fistula
• Episodic (mins-hrs)
 Meniere’s disease
• Prolonged (days-weeks)
 Initial stage of acute
labyrinthitis & vestibular
neuronitis
Non rotatory
• Episodic (few secs)
 Rapid body movements
• Episodic (mins-hrs)
 Hypoglycemia
 Motion sickness
 Ototoxic drugs
• Prolonged (days-weeks)
 Later stages of acute
labyrinthitis & vestibular
neuronitis
 Cerebellar lesion
 Ototoxic drugs
Differential diagnosis of vertigo

11. Ototoxic drugs
• Aminoglycosides
 Gentamycin-mainly vestibulotoxic, reversible damage
 Streptomycin, kanamycin- both vestibulotoxic &
cochleotoxic, permanent damage
• Cytotoxic agents
 SCC of head & neck-Cisplatin, carboplatin
• Loop diuretics
 Mainly cochleotoxic
 Furosemide, ethacrynic acid
• Salicylates (Aspirin)
• Quinine
• Others (Phenytoin, alcohol)

12. References
• R P Shrivastav. An Illustrated Textbook Ear, Nose &
Throat and Head & Neck surgery. 2nd edition. Jaypee.
Chapter 16.
• Grist WJ. Hoarseness. In: Walker HK, Hall WD, Hurst JW,
editors. Clinical Methods: The History, Physical, and
Laboratory Examinations. 3rd edition. Boston:
Butterworths; 1990. Chapter 125.
• Reiter R, Hoffmann TK, Pickhard A, Brosch S.
Hoarseness-causes and treatments. Dtsch Arztebl Int.
2015;112(19):329-337.
• www.FauquierENT.net