II. Epidemiology
- Hoarseness is common, with a point Prevalence as high as 7% for those <65 years old
III. Pathophysiology
- Abnormal voice production (change in pitch, loudness or effort)
- Breathiness
- Harsh, rough or raspy voice
- Lack of smooth vocal cord approximation
- Laryngeal pathology
- Abnormal vocal cord mobility
- Usually caused by organic disorder (not functional)
IV. Causes
V. Symptoms
- Abnormal voice quality (e.g. Breathy, Strained, Raspy, Weak)
VI. History
VII. Evaluation: Laryngoscopy Indications (see Laryngeal Examination)
- More than 4 weeks of Hoarseness despite specific management trials (see below)
- More than 2 weeks of symptoms and risk factors for Laryngeal Cancer
- Tobacco Abuse
- Alcohol Abuse
- Gastroesophageal Reflux disease (esp. if longstanding or with Dysphagia)
- Hemoptysis
VIII. Management: Suspect benign causes (esp. in first 2 weeks of symptoms)
- See Acute Laryngitis
- See Chronic Laryngitis
- Consider Laryngoscopy if Hoarseness persists despite empiric management
- General measures: Vocal Hygiene
-
Upper Respiratory Infection, allergy, or Voice Abuse
- Voice rest and symptomatic treatment
-
Gastroesophageal Reflux symptoms (suggests Reflux Laryngitis)
- Trial on Proton Pump Inhibitor (expect improvement by 4 weeks)
-
Inhaled Corticosteroid use
- Use spacer with Inhaler
- Gargle and rinse mouth (or drink water after)
- If using Fluticasone, Budesonide or Beclomethasone, consider substituting other Inhaled Corticosteroid
- Consider reducing or trialing off Inhaled Corticosteroid (expect improvement in 4 weeks)
- Underlying systemic or neuromuscular condition (e.g. Hypothyroidism, Parkinsonism)
- Treat the underlying cause
- Voice therapy indications (Behavior Modification training in 30-60 min weekly sessions for 8-10 weeks)
- Significantly vocal dysfunction
- Nonorganic Dysphonia
- Benign Vocal Fold Lesions
- Age-related vocal atrophy
- Preventive
- Vocalist, singer or public speaker
- Significantly vocal dysfunction
IX. Management: Temporary voice restoration prior to performance
- Indications
- Professional singer or speaker and
- Vocal fold edema present by Nasolaryngoscopy
- Contraindications
- Vocal fold Hemorrhage, abrasion by Nasolaryngoscopy
- Preparations (not FDA approved)
- Voice rest is preferred
- Results in faster healing time
- Prednisone 40 mg PO given 4 hours prior to event
- Corticosteroids do not decrease healing time
- Not generally recommended
- Afrin sprayed directly on Larynx
- Voice rest is preferred
- References
- Woodson in Rakel (2003) Conn's Therapy, p. 210
- Postma in Cummings (1998) Otolaryngology, p. 2064
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Related Studies
| Definition (NCI_CTCAE) | A disorder characterized by harsh and raspy voice arising from or spreading to the larynx. |
| Definition (NCI) | Harsh and raspy voice secondary to laryngeal infection, voice overuse, irritants inhalation, vocal cord paralysis, vocal cord polyps, and malignant neoplasms arising from or spreading to the larynx. |
| Definition (MSH) | An unnaturally deep or rough quality of voice. |
| Concepts | Sign or Symptom (T184) |
| MSH | D006685 |
| ICD10 | R49.0 |
| SnomedCT | 206974000, 50219008, 158311009, 162393004, 139661005, 162391002, 139663008, 139664002 |
| English | Hoarseness, Hoarsenesses, HOARSENESS, [D]Hoarseness, Hoarseness symptom NOS, [D]Hoarseness (context-dependent category), Hoarse voice quality, hoarseness (symptom), hoarseness, Hoarseness of Voice, Voice Hoarseness, Hoarseness [Disease/Finding], husky voice, hoarse, hoarse voice, Hoarseness;voice, Hoarseness, Voice, [D]Hoarseness (situation), Hoarseness symptom NOS (finding), Hoarse, Hoarseness - throat symptom, Hoarseness symptom, Voice hoarseness, Croaky voice, Husky voice, Hoarse (finding), Hoarse voice, Hoarseness of voice, hoarseness of voice |
| French | ENROUEMENT, Voix enrouée, Enrouement de la voix, Enrouement |
| Portuguese | ROUQUIDAO, Rouquidão da voz, Voz rouca, Rouquidão |
| Spanish | RONQUERA, Voz ronca, [D]ronquera (categoría dependiente del contexto), síntoma de ronquera, SAI, síntoma de ronquera, SAI (hallazgo), Hoarseness symptom NOS, [D]ronquera, [D]ronquera (situación), carraspera, voz ronca (hallazgo), voz ronca, Ronquera |
| German | HEISERKEIT, Heiserkeit der Stimme, heisere Stimme, Heiserkeit |
| Dutch | heesheid van de stem, hese stem, heesheid, Heesheid |
| Italian | Raucedine della voce, Voce roca, Voce rauca, Raucedine |
| Swedish | Heshet |
| Japanese | ｻｾｲ, 嗄声, さ声, しわがれ声 |
| Czech | chrapot, Chrapot v hlase, Chraptivý hlas, Chrapot |
| Finnish | Käheys |
| Russian | OKHRIPLOST', ОХРИПЛОСТЬ |
| Polish | Chrypka |
| Hungarian | Rekedtség |
| Norwegian | Heshet |
Ontology: Laryngitis (C0023067)
| Definition (MSH) | Inflammation of the LARYNGEAL MUCOSA, including the VOCAL CORDS. Laryngitis is characterized by irritation, edema, and reduced pliability of the mucosa leading to VOICE DISORDERS such as APHONIA and HOARSENESS. |
| Definition (CHV) | an inflammation of the larynx (voice box) generally associated with hoarseness or loss of voice |
| Definition (MSHCZE) | Zánět hrtanu. Probíhá samostatně nebo častěji jako součást zánětu horních cest dýchacích. Nejčastěji má virový původ, ale může být způsobena i bakteriemi a zevními vlivy (dráždivé plyny, inverzní l. aj.). Projevuje se chrapotem až ztrátou hlasu (afonií) a kašlem. V těžkých případech, zejm. u malých dětí, může zduření hrtanu způsobit až dušení. Viz laryngitis. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ ) |
| Definition (NCI_NCI-GLOSS) | Inflammation of the larynx. |
| Definition (NCI) | An acute or chronic, bacterial or viral inflammatory process affecting the larynx. Signs and symptoms include sore throat, cough, swallowing difficulties, and hoarseness. |
| Definition (NCI_CTCAE) | A disorder characterized by an inflammatory process involving the larynx. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D007827 |
| SnomedCT | 45913009 |
| English | Laryngitides, LARYNGITIS, laryngitis, laryngitis (diagnosis), Laryngitis NOS, Laryngeal Inflammation, Laryngitis, Laryngitis [Disease/Finding], Larynx inflamed, Laryngitis (disorder), Laryngitis, NOS, Laryngeal inflammation |
| French | LARYNGITE, Inflammation du larynx, Laryngite SAI, Laryngite |
| Portuguese | LARINGITE, Inflamação laríngea, Laringite NE, Laringite |
| Spanish | LARINGITIS, Inflamación laríngea, Laringitis NEOM, laringitis (trastorno), laringitis, Laringitis |
| German | LARYNGITIS, Kehlkopfentzuendung, Laryngitis NNB, Laryngitis, Kehlkopfentzündung |
| Dutch | strottenhoofd ontsteking, laryngitis NAO, laryngitis, Laryngitis |
| Italian | Infiammazione laringea, Laringite NAS, Laringite |
| Japanese | 喉頭の炎症, 喉頭炎ＮＯＳ, 喉頭炎, ｺｳﾄｳﾉｴﾝｼｮｳ, ｺｳﾄｳｴﾝ, ｺｳﾄｳｴﾝNOS |
| Swedish | Strupkatarr |
| Czech | hrtan - zánět, zánět hrtanu, laryngitida, Laryngitida NOS, Laryngitida, Zánět hrtanu |
| Finnish | Kurkunpäätulehdus |
| Russian | LARINGIT, ЛАРИНГИТ |
| Polish | Zapalenie krtani |
| Hungarian | laryngitis, laryngitis k.m.n., Gége gyulladás |
| Norwegian | Laryngitt, Strupekatarr |
