1. What is Hoarseness? Diplophonia
Splitting of the fundamental frequency of the voice into 2 different frequencies

2. Rule of Thumb
Any patient with hoarseness of two weeks duration or longer must undergo visualization of the vocal cords

3. Causes of Hoarseness Congenital Acquired Laryngeal web Nerve paralysis
Papillomatosis
Acquired
Iatrogenic
Non-iatrogenic
Disease related
Traumatic

4. Iatrogenic Causes of Hoarseness
Surgery
Thyroid
Parathyroid
Carotid endarterectomy
Chest/cardiac esp. left side
Neck dissection
Anterior approach to C-spine
Laryngeal surgery (endoscopic or open)
Skull base procedures

5. Iatrogenic Causes of Hoarseness
General anesthesia
Arytenoid dislocation
Intubation granuloma
Cord laceration
Radiation therapy
Medical and/or hormonal therapy

6. Non-iatrogenic Causes of Hoarseness
Disease related
Inflammatory disease
Viral
Bacterial
Fungal
Benign laryngeal lesions
Vocal polyp
Vocal nodule
Vocal cyst
Contact ulcer or granuloma from reflux
Papillomatosis
Amyloidosis
Granulomatous diseases

7. Non-iatrogenic Causes of Hoarseness
Disease related – cont.
Allergy - PND
Neuromuscular disease
Auto-immune disease
Endocrine disorders
Pre-malignant lesions
Leukoplakia
Erythroplakia
Hyperkeratosis
Malignant lesions
Squamous ca larynx or pharynx
Thyroid ca invading nerve or larynx
Rare laryngeal tumors

8. Non-iatrogenic Causes of Hoarseness
Traumatic (external)
Penetrating
Blunt

9. History Age Occupation
Child – excessive screaming
Geriatric - vocal atrophy, poor conditioning of abdominal and pulmonary musculature
Occupation
Voice over use/ abuse
Toxic exposure – smoking, Alchohol, pollutants, pollens directly toxic
Reflux – GERD and LPRD
Heartburn absent in 70% of pts

10. History
Hormonal - thyroid, estrogen - edema of lamina propria = decreased elasticity
Medications - androg hormones - permanent
Asprin, NSAIDS, antihistamines, diuretics
Food products - milk – casein
Surgical history - laryngeal, abdominal, thoracic
Neurologic history
Psychiatric history

11. Exam
Complete ENT exam for every new patient with emphasis on laryngeal and neck exam
Indirect laryngoscopy
Fiberoptic laryngoscopy
Flexible
Rigid
Laryngostroboscopy

12. Consultations Speech, Speech, Speech GI med - ph probes Pulmonary
Neurology
Psychiatry