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Hoarseness of voice. General term which describe abnormal voice changeHaving difficulty in producing the sound when trying to speakChange in a pitch and quality of the voice The voice may sound weak, very breathy, scratchy or husky. Larynx. Also known as voice boxLined with ciliated columnar e
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1. HOARSENESS IN VOICEnoor majeed rehani
2. Hoarseness of voice General term which describe abnormal voice change
Having difficulty in producing the sound when trying to speak
Change in a pitch and quality of the voice
The voice may sound weak, very breathy, scratchy or husky
3. Larynx Also known as voice box
Lined with ciliated columnar epithelium
Vocal cord- lined with squamous epithelium
Have cartilages :
Epiglottis
Cricoid cartilages
Thyroid cartilages
Nerve supply :
Motor : all the muscle which move the vocal cord are supplied by recurrent laryngeal nerve except cricothyroid muscle which supplied by external laryngeal nerve
Sensory : above the vocal cord supplied by internal laryngeal nerve & below the vocal cord by recurrent laryngeal nerve
4. Function of the larynx :
Protection of lower airways
Phonation
Respiration
Fixation of the chest
9. HISTORY
10. PHYSICAL EXAMINATION
11.
Voice is produced by the following mechanism:
Vocal cord are kept adducted
Infraglottic air pressure is generated by exhaled air from the lungs due to contraction of thoracic & abdominal muscles
The air force open the cords & is released a small puff which vibrates the vocal cord and produced sound which is amplified by mouth pharynx, nose & chest
Cord may not be able to vibrate properly in the presence of congestion sub mucosal hemorrhage, nodules or polyps
12. Causes of Hoarseness of voice Congenital : laryngeal web , cyst , laryngocele
Paralysis : paralysis of recurrent laryngeal nerve, superior laryngeal or both nerves
Inflammation : acute & chronic laryngitis, laryngo-tracheo-bronchitis, diptheria, acute epiglottitis
Neoplastic : vocal cord polyps, nodules, granuloma, cysts , laryngeal carcinoma, leukoplakia.
Neuromuscular: vocal cord palsy, spasmodic dysphonia, movement disorder, Parkinson disease, CVA.
Miscellaneous: vocal abuse, vocal cord atrophy, vocal cord scarring, hypothyroidism, Reinke’s edema, GERD, postnasal drip.
13. Acute Laryngitis Infectious type :
Follows upper respiratory tract infection
Often viral in origin but bacterial will act as superadded infection ; strepcoccus, H.influenza, haemolytic strepcoccus & staph. Aureus
Non infectious type :
- vocal abuse
- allergy
- thermal/ chemical burn to larynx
- laryngeal trauma
- smoking/ alcohol
14. Presentation :
Aphonia / dysphonia
Cough : dry, painful & irritating
Stridor : rare but potentially serious
Pain throat : after talking
Examination :
Indirect laryngoscopy : shows a red swollen larynx
Sometimes, present stringy mucus between cords
Treatment :
Vocal rest
Avoidance of smoking & alcohol
15. INDIRECT LARYNGOSCOPY
16. NORMAL LARYNGEAL STRUCTURES
17. ACUTE LARYNGITIS
18. Chronic Laryngitis Predisposing causes:
Alcohol
Habitual shouting / faulty voice production
Dysphonia results due to laryngeal muscle imbalance
Voice: hoarse & fatigue easily
Can turn into carcinoma if patient continues to smoke
Treatment:
Voices should be rested
Treat upper airway sepsis
Steam inhalation
19. CHRONIC LARYNGITIS
20. Vocal Cord Paralysis Common : unilateral
Patient will have hoarse breathing voice : due to inability of vocal
cord to appose
In severe case : patient will aspirate food & saliva
The main cause is left recurrent nerve palsy
Bronchogenic carcinoma - Esophageal carcinoma
Thyroid surgery - Cardiac & esophageal surgery
Aortic aneurysm - Malignant mediastinal nodes
Treatment : identify the cause & treat it
In unilateral : voice will improve due to compensation by the healthy cord which crosses the midline to meet paralysed one
22. nodules Occur in adults and child
As a result of excessive vocal use
Nodules : small, smooth nodules on the free edge of each cord
Comprised of fibrous tissue covered with eipthelium
Treated by voice rest, speech therapy & brarely removed surgically
23. Vocal cord polyps Also result of vocal abuse or misuse
Other causes : allergy & smoking
Polyps :
unilateral
arises from the same position as vocal nodules
Soft, smooth & pedunculated
May flop up & down the glottis during respiration & phonation
Treatment : surgical excision
24. leukoplakia Localized form of epithelial hyperplasia
Involving upper surface of one or both vocal cord
Appears as white plaque or warty growth on the cord without affecting its mobility
Treatment: stripping of vocal cord & subjecting the tissue to histology for any malignant change
25. SMOKER WITH CHRONIC LARYNGITIS & LEUKOPLAKIA
26. Investigation History : mode of onset and duration of illness, patient’s occupation, habits & associated complaints
Indirect laryngoscopy
Examination of neck, chest, cardiovascular & neurological symptom : to find the cause of laryngeal paralysis
Laboratory investigations & radiological examination
Direct laryngoscopy & microlaryngoscopy:
Bronchoscopy & oesophagoscopy : in case paralytic lesions to exclude malignancy
27. Treatment The treatment depends on the causes
Most hoarseness are treated by simply resting the voice & modifying how it is used