HOARSENESS OF VOICE

Aetiology

1. Laryngeal causes

(a) Congenital

(b) Traumatic

1. External- strangulation, injury neck, etc.

2. Internal instrumentation, fumes, operative, etc.

(c) Inflammatory

1. Acute- acute laryngitis, oedema larynx, etc.

2. Chronic- chronic laryngitis, singer's node, etc.

3. Specific- T. B., syphilis, etc.

(d) Neoplastic

(i) Benign-papilloma, vocal nodule, fibroma, angioma, etc.

(ii) Malignant- carcinoma commonly.

(e) Paralytic- motor paralysis.

(f) Allergic- angio-neurotic oedema.

(g) Functional or hysterical

(h) Miscellaneous- dysphonia plica ventricularis.

2.Pharyngeal & Oesophageal causes

(a) Hypopharyngeal carcinoma involving larynx.

(b) Pharyngeal pouch.

(c) Carcinoma oesophagus

3. General causes- Myxoedema, renal or cardiac oedema, other causes of anasarca, etc.

4. Neck (including thyroid disease) and mediastinal causes: leading to laryngeal nerve paralysis

Diagnosis

(a) Careful history- Age of the patient, profession; sudden or progressive; since birth or not; whether clears up with voice rest; H/O trauma; Associate symptoms eg: cough, fever, sore throat, earache, difficulty in swallowing, loss of weight, anorexia, etc.

(b) Clinical examination

(i) Oro-pharyngeal including dental examination.

(ii) Laryngeal and hypopharyngeal examination by indirect laryngoscopy.

(iii) Neck including thyroid.

(iv) General, neurological, cardio-vascular, pulmonary, etc.

(c) Investigations

(i) Haematological- TC., D.C., Hb%, ESR., WR. & V.D.R.L., etc.

(ii) Radiological- X-ray chest, base of the skull, soft tissue X-ray of the neck (lateral), etc.

(iii) Barium-swallow x-ray of the oesophagus.

(iv) Tomogram, & CT scan of neck, & chest.

(v) Contrast laryngography.

(vi) Cardiac catheterisation & E.C.G to show cardiomegaly and cardiac failure

(vii) Laryngeal swab and smear; Sputum for A.F.B.

(viii) Direct laryngoscopy (preferably micro-laryngoscopy); biopsy and histopathology.

(ix) Bronchoscopy & Oesophagoscopy.

(x) Mediastinoscopy

 

TREATMENT AT DR. SOHAN LAL CLINIC

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