1. Laryngeal causes
1. External- strangulation, injury neck, etc.
2. Internal instrumentation, fumes, operative, etc.
1. Acute- acute laryngitis, oedema larynx, etc.
2. Chronic- chronic laryngitis, singer's node, etc.
3. Specific- T. B., syphilis, etc.
(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
(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.
(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.
TREATMENT AT DR. SOHAN LAL CLINIC
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