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

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

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

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

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

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

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

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

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

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

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

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