II. Epidemiology

  1. Hoarseness is common, with a point Prevalence as high as 7% for those <65 years old

III. Pathophysiology

  1. Abnormal voice production (change in pitch, loudness or effort)
    1. Breathiness
    2. Harsh, rough or raspy voice
  2. Lack of smooth vocal cord approximation
    1. Laryngeal pathology
    2. Abnormal vocal cord mobility
  3. Usually caused by organic disorder (not functional)

IV. Causes

V. Symptoms

  1. Abnormal voice quality (e.g. Breathy, Strained, Raspy, Weak)

VI. History

VII. Evaluation: Laryngoscopy Indications (see Laryngeal Examination)

  1. More than 4 weeks of Hoarseness despite specific management trials (see below)
  2. More than 2 weeks of symptoms and risk factors for Laryngeal Cancer
    1. Tobacco Abuse
    2. Alcohol Abuse
    3. Gastroesophageal Reflux disease (esp. if longstanding or with Dysphagia)
    4. Hemoptysis

VIII. Management: Suspect benign causes (esp. in first 2 weeks of symptoms)

  1. See Acute Laryngitis
  2. See Chronic Laryngitis
  3. Consider Laryngoscopy if Hoarseness persists despite empiric management
  4. General measures: Vocal Hygiene
    1. Voice rest (do not whisper!)
    2. Avoid Tobacco, Alcohol and other irritants
    3. Consider humidifier
    4. Avoid raising voice volume
  5. Upper Respiratory Infection, allergy, or Voice Abuse
    1. Voice rest and symptomatic treatment
  6. Gastroesophageal Reflux symptoms (suggests Reflux Laryngitis)
    1. Trial on Proton Pump Inhibitor (expect improvement by 4 weeks)
  7. Inhaled Corticosteroid use
    1. Use spacer with Inhaler
    2. Gargle and rinse mouth (or drink water after)
    3. If using Fluticasone, Budesonide or Beclomethasone, consider substituting other Inhaled Corticosteroid
    4. Consider reducing or trialing off Inhaled Corticosteroid (expect improvement in 4 weeks)
  8. Underlying systemic or neuromuscular condition (e.g. Hypothyroidism, Parkinsonism)
    1. Treat the underlying cause
  9. Voice therapy indications (Behavior Modification training in 30-60 min weekly sessions for 8-10 weeks)
    1. Significantly vocal dysfunction
      1. Nonorganic Dysphonia
      2. Benign Vocal Fold Lesions
      3. Age-related vocal atrophy
    2. Preventive
      1. Vocalist, singer or public speaker

IX. Management: Temporary voice restoration prior to performance

  1. Indications
    1. Professional singer or speaker and
    2. Vocal fold edema present by Nasolaryngoscopy
  2. Contraindications
    1. Vocal fold Hemorrhage, abrasion by Nasolaryngoscopy
  3. Preparations (not FDA approved)
    1. Voice rest is preferred
      1. Results in faster healing time
    2. Prednisone 40 mg PO given 4 hours prior to event
      1. Corticosteroids do not decrease healing time
      2. Not generally recommended
    3. Afrin sprayed directly on Larynx
  4. References
    1. Woodson in Rakel (2003) Conn's Therapy, p. 210
    2. Postma in Cummings (1998) Otolaryngology, p. 2064

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Related Studies

Ontology: Hoarseness (C0019825)

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
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
Polish Zapalenie krtani
Hungarian laryngitis, laryngitis k.m.n., Gége gyulladás
Norwegian Laryngitt, Strupekatarr