This document discusses hoarseness, including its definition, anatomy, etiology, clinical evaluation, differential diagnosis, and management. Hoarseness refers to any change in voice quality and can be caused by infections, polyps, smoking, acid reflux, and other factors. The clinical evaluation of hoarseness involves taking a medical history, performing a physical exam including laryngoscopy, and considering differential diagnoses such as laryngitis, vocal fold lesions, laryngeal carcinoma, and neurologic dysfunction. Treatment depends on the underlying cause but may include voice rest, voice therapy, pharmacotherapy, and surgery.

1. Hoarseness
Abdullatiff Sami Al-Rashed
Block 4.2
College of Medicine, King Faisal University
Al-Ahsa, Saudi Arabia

2. Objectives
Treatment
Deferential Diagnosis
Clinical evaluation
Etiology of Hoarseness
Anatomy of Larynx
Definition of Hoarseness

3. Definition
• "Hoarseness" is a term often used to describe any
change in voice quality.
• May be manifested as a voice that sounds breathy,
strained, rough, raspy, tremorous, strangled, or weak, or
a voice that has a higher or lower pitch

4. Anatomy

5. Anatomy

6. Anatomy

7. Anatomy

8. Etiology
•Hoarseness may be caused by:
Infections Polyps Smoking Alcohol abuse
Voice Abuse Acid Reflux Other causes

9. • Hoarseness videos:

10. Clinical Evaluation
• History should includes the following:
Other head and neck symptoms (eg, dysphagia, otalgia, odynophagia, bleeding,
postnasal drip)

11. Clinical Evaluation
• History should includes the following:

12. Clinical Evaluation
• Physical Examination:
• The physical examination should begin by noting the
quality of the patient's voice.
• Although not absolutely definitive, various voice qualities
may correlate with underlying etiologies for the voice
disorder.

13. Clinical Evaluation
• Physical Examination:
• All patients presenting with hoarseness should receive a
thorough physical examination to identify any underlying
causative medical conditions.
• Particular attention should be given to examination of:

14. Clinical Evaluation
• Head and Neck Examination:
• Examination should include inspection and palpation for masses
and enlargement of:

15. Clinical Evaluation
• Head and Neck Examination:
• Visualization of the larynx, using either indirect
laryngoscopy or flexible nasolaryngoscopy is central to
the evaluation.

16. Clinical Evaluation
• Neurological examination
• The patient should be examined for:
• Progressive dysarthria, vocal weakness, fatigability, gait
abnormalities, rigidity (cogwheel), resting and intention tremor,
bradykinesia (masked facies, decreased arm swing, shuffling gait),
hyper/hypo-nasality, and dysphagia (choking on solids or liquids,
effortful swallowing).

17. Clinical Evaluation
• Respiratory examination
1. Inspiratory or biphasic stridor.
2. Dyspnea.
3. Respiratory distress with accessory muscle use and
tachypnea.
4. Shortness of breath while speaking with the inability to
complete sentences in a single breath, and/or a non-
productive cough.
• These are important signs of airway obstruction and require
immediate attention.

18. Deferential Diagnosis

19. Acute laryngitis
• Acute laryngitis is a common and self-limited
inflammatory condition lasting less than three weeks,
and usually associated with either an upper respiratory
tract infection or acute vocal strain.
• It is the most common cause of hoarseness.

20. Chronic laryngitis
• When laryngitis persists beyond three weeks, it is
defined as chronic laryngitis
• Typically related to irritants (such as chemical fumes),
reflux, chronic infection (such as fungal), or habitual
vocal misuse

21. Benign Vocal Fold Lesions

22. Polypoid Corditis (Reinke's Edema)
Viscous material accumulates in the Reinke's space
of the true vocal folds as a result of chronic irritation
and inflammation secondary to smoking.
Affects women over 40 who are smokers & frequent
professional speakers
Causing Hoarseness & deepening of voice. (patient
often complains of “sounding like a man.”)

23. Reinke edema

24. Polyps
• The most common cause of benign tumor of the vocal
cords.
• Caused by smoking or voice abuse.
• Usually unilateral.

25. Vocal Nodules
• More common in women and children, and are
also frequently seen in the setting of vocal
abuse.

26. Laryngeal Carcinoma
• Usually squamous cell carcinoma.
• Major risk factors include smoking and alcohol abuse.

27. Neurologic dysfunction

28. Management
Treatment options for hoarseness vary
depending on the underlying etiology.
Treatment generally consists of voice rest,
voice therapy,
pharmacotherapy, and/or surgery
Treatment options for hoarseness vary
depending on the underlying etiology.
Treatment generally consists of voice rest,
voice therapy,
pharmacotherapy, and/or surgery

29. Management
Disease Management lines
Acute laryngitis hydration, humidification, and voice rest.
Resolve spontaneously
Chronic laryngitis Chronic laryngitis due to irritants
generally resolves with removal of the
offending agent.
Reinke's edema smoking cessation, reflux management,
and voice therapy. Surgical debulking /
recontouring may be necessary in
certain cases.
Polyps usually requires surgical removal of the
polyps
Nodules aimed at correcting vocal strain and
maladaptive vocal habits, and usually
does not require surgery.

30. References