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