Hoarseness History

Aka: Hoarseness History, Laryngitis History

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II. History: Exposure

  1. Surgical history
    1. Intubation risks direct Laryngeal Trauma
    2. Head, neck or chest surgery risks Vagus Nerve or recurrent laryngeal nerve Trauma
  2. Voice Abuse
    1. Vocalist or singer
    2. Public speaking, teaching or telemarketing
    3. Umpire or coach
  3. Tobacco Abuse
    1. Differential Diagnosis: Laryngeal Cancer, Leukoplakia, Reinke edema or Chronic Laryngitis
  4. Alcohol Abuse
    1. Differential Diagnosis: Risk of Laryngeal Cancer or Reflux Laryngitis

III. History: Onset

  1. Acute (without Trauma or Foreign Body Ingestion)
    1. Viral Laryngitis
    2. Bacterial Laryngitis or Acute Epiglottitis
  2. Chronic
    1. Voice Abuse
    2. Smoke exposure
    3. Laryngeal Neoplasm
    4. Gastroesophageal Reflux (Reflux Laryngitis)

IV. History: Timing

  1. Evening Onset: Neuromuscular cause
    1. Myasthenia Gravis
    2. Recurrent Laryngeal Nerve Palsy
  2. Morning Onset
    1. Gastroesophageal Reflux (Reflux Laryngitis)
  3. Constant Hoarseness: Larynx Structural Change
    1. Laryngeal Neoplasm
    2. Laryngeal Trauma
    3. Functional Aphonia
    4. Dysphonia Plicae Ventricularis
  4. Intermittent Hoarseness: Benign or transient cause
    1. Voice Abuse
    2. Postnasal drainage

V. History: Associated symptoms

  1. Pharyngitis, Otalgia, and Dysphagia for more than 2 weeks
    1. Laryngeal Neoplasm
  2. Dysphagia or odynophagia
    1. Laryngeal Cancer
    2. Inflammatory Arthritis
    3. Reflux Esophagitis
  3. Dyspnea
    1. Laryngeal Neoplasm
    2. Bilateral vocal cord palsy
    3. Acute Epiglottitis
  4. Wheezing or Asthma
    1. Allergy
    2. Inhaled Corticosteroid
  5. Laryngeal pain
    1. Contact laryngeal ulcer
    2. Cricoarytenoid joint Arthritis or fixation
    3. Viral Laryngitis
    4. Bacterial Laryngitis
    5. Laryngeal Foreign Body
  6. Throat clearing
    1. Allergic Rhinitis
    2. Inhaled Corticosteroids (esp. Flovent)
    3. Reflux Laryngitis
  7. Aspiration
    1. Tracheoesophageal fistula
    2. Unilateral vocal cord palsy (breathy, raspy voice)
    3. Weight loss
    4. Laryngeal Neoplasm
  8. Cough, Hemoptysis, Chest Pain
    1. Intrathoracic cause
  9. Stridor
    1. Laryngeal Cancer
    2. Laryngeal papillomatosis
    3. Vocal Cord Dysfunction
  10. Fever
    1. Viral Laryngitis
    2. Bacterial Laryngitis or Acute Epiglottitis
  11. Generalized weakness, no weight loss
    1. Neuromuscular Causes

VI. History: Voice Quality

  1. Breathy voice
    1. Inflammatory Arthritis
    2. Functional Dysphonia
    3. Vocal Cord Paralysis
    4. Vocal cord lesion
  2. Strangled or halting voice
    1. Spasmodic Dysphonia
  3. Husky, muffled or nasal voice
    1. Parkinsonism
  4. Harsh, raspy voice or strained voice
    1. Reflux Laryngitis
    2. Vocal cord lesion
    3. Functional Dysphonia
  5. Honking voice
    1. Sarcoidosis
  6. Low-pitched voice
    1. Hypothyroidism
    2. Reflux Laryngitis
    3. Functional Dysphonia
    4. Vocal Cord Paralysis
    5. Vocal cord inflammation or edema (Reinke edema or more generalized, Leukoplakia)
    6. Muscle tension Dysphonia
  7. Soft voice
    1. Vocal Cord Paralysis
    2. Parkinsonism
  8. Vocal Fatigue
    1. Functional Dysphonia
    2. Myasthenia Gravis
    3. Parkinsonism
    4. Vocal Abuse
    5. Age-related vocal atrophy
  9. Other specific voice types
    1. Acromegaly
      1. Thick, deep voice with slowed speech
    2. Multiple Sclerosis
      1. Scanning speech and Dysarthria

VII. References

  1. Dworkin (2008) Otolaryngol Clin North Am 41(2):419-36 [PubMed]
  2. Feierabend (2009) Am Fam Physician 80(4): 363-70 [PubMed]
  3. House (2017) Am Fam Physician 96(11): 720-8 [PubMed]

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