Possible causes based on descriptionĭuring the respiratory examination, listen for stridor. If the cough is breathy and ineffective it can suggest poor glottic closure and an impairment of vocal cord movement.
9 Ask the patient to cough and listen to the quality. This maximal phonation time can vary, but if less than eight seconds it often indicates an organic pathology. 7,8 During this period, ask the patient to sustain the vowel sound ‘ah’ for as long as they can and time it. Table 1 provides some examples of common voice changes and associated diagnoses. First, listen to the voice and note the quality, pitch and volume. Many differential diagnoses can be excluded with a thorough head, neck and chest examination. The examination for hoarseness can be difficult because the larynx cannot be visualised. Social history should include both work as well as co-curricular activities.
Hoarse voice professional#
Professional voice users are particularly prone to voice hoarseness. Associated systemic diseases can include hypothyroidism, neurological disease such as Parkinson’s disease or myasthenia gravis, and inflammatory or autoimmune conditions, such as rheumatoid arthritis. Similarly, a recent intubation (especially if prolonged or traumatic) may have resulted in laryngeal injury. Ascertain if the patient has had any recent surgery or trauma to the neck or chest as the RLN may have been damaged. If a patient is using a steroid inhaler, check how they use it and if gargling is performed after each use. History should include the presence of heartburn or any recent upper respiratory tract infections. Hoarseness that is intermittent in nature is less likely to be due to a fixed lesion. 4,5 If any of these are present and the hoarseness is persistent, an urgent referral to an otorhinolaryngologist should be made. Important red flags include a history of smoking, dysphagia, odynophagia or otalgia, stridor, haemoptysis and recent fevers, night sweats and unexplained weight loss. Taking a history from a patient presenting with hoarseness is similar to any other presenting complaint. Damage of the nerve may be due to apical lung masses, direct injury during trauma or surgery, post-operative oedema and, occasionally, unknown aetiology. The left RLN is more commonly injured, most likely because of the longer course. After leaving the vagus nerve, on the right it loops around the subclavian artery and on the left around the aortic arch, then ascends slightly anterior to the tracheoesophageal groove to where it enters the larynx. The course of the RLN is complex and leaves it vulnerable to damage during cervical and thoracic procedures. An example of this is Reinke’s oedema, an oedema of the superficial lamina propria that results in a deep voice and is most commonly caused by smoking and voice overuse.Īll of the intrinsic muscles of the larynx (except cricothyroid) are innervated by the recurrent laryngeal nerve (RLN). Damage to any of these layers or the space between the layers can affect the voice. The vocal cords are made up of multiple layers and voice is created by vibrations of the outer layers due to the passing air.
Internal view of the larynx during inspirationĭeep within the larynx are the vocal cords, which create the sound (Figure 2). Reproduced with permission from Shutterstock Netherlandsįigure 2. These can occasionally be affected by joint disease, such as rheumatoid arthritis or systemic lupus erythematosus. There are synovial joints between the thyroid and cricoid cartilages and the cricoid and arytenoid cartilages. 3 It consists of three single cartilages: the thyroid, cricoid and epiglottic and three paired cartilages: the arytenoid, cuneiform and corniculate cartilages, interconnected by ligaments and muscles.
The larynx is a complex structure that stretches from the base of the tongue to the trachea and lies opposite the third to sixth cervical vertebrae (Figure 1). Pathology of any one of these components may affect a person’s voice. the nervous system, which provides overall control.the resonance chamber made up of the pharynx, nasal and oral cavities, which project the sound.the larynx and, specifically, the vocal cords to create the sound.the lungs to provide a sufficient air stream through the vocal cords.This article will outline an approach to assessing hoarseness, discuss management of common benign causes and when to refer to an otorhinolaryngologist. 2 Diagnosing and treating the cause of hoarseness can be difficult. It is estimated to affect up to one-third of the adult population 1 at some point in their lives and one-tenth of children. Hoarseness, a general term used to describe any change in the character of a patient’s voice, is a common presenting complaint among all population groups.
0 kommentar(er)
