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Dysphonia – Diagnosis, Decisive action and other Delights

Dysphonia – Diagnosis, Decisive action and other Delights. Dave Pothier St Michaels Hospital March 2004. Definition.

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Dysphonia – Diagnosis, Decisive action and other Delights

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  1. Dysphonia –Diagnosis, Decisive action and other Delights Dave Pothier St Michaels Hospital March 2004

  2. Definition • dysphonia [dıs'fəΏnıə]noun  any impairment in the ability to speak normally, as from spasm or strain of the vocal cords[ETYMOLOGY: 18th Century: New Latin, from Greek: harshness of sound, from dys- + -phonia -phony] dysphonic [dıs'fβnık] adjective

  3. Definition • Any abnormality of quality of sound of voice from any cause • Not necessarily from cords • Almost synonymous with hoarseness

  4. Context • Common referral • Potentially sinister symptom • Many benign causes

  5. Anatomy / physiology • Vagus nerve • Larynx

  6. Vagus nerve SLN: Internal br. – Sensation above cords External br. - cricothyroid muscle RLN: All other muscles Sensation below cords

  7. Larynx

  8. Cords

  9. Diagnosis “Any patient with hoarseness of __________ duration or longer must undergo visualization of the vocal cords” two weeks

  10. Workup History Examination Investigations

  11. History • URI • Trauma (blunt and sharp to skull + neck) • Intubation • Pulmonary problems

  12. History • Gastrointestinal • LPR • Autoimmune • RA • Endocrine • Hypothyroidism

  13. Neurologic disorders

  14. Surgical History • Skullbase procedures • Carotid endarterectomies • Thyroidectomies • Aortic aneurysm repairs

  15. Medications

  16. Social History Tobacco Alcohol LOW

  17. Occupational History Levels of voice use: Level 1 – singer / actor Level 2 – teacher Level 3 – doctor / lawyer Level 4 – bricklayer

  18. Associated Symptoms

  19. Examination • General Examination • Full ENT Exam • Other systems • Chest

  20. Investigations Nasendoscopy Indirect laryngoscopy

  21. Imaging • CT • Chest • Neck • MRI

  22. Direct pharyngolaryngoesophagoscopy • Tissue diagnosis • Panendoscopy with direct vision

  23. Direct pharyngolaryngoesophagoscopy • NB subglottis must be visualised

  24. Causes Neurological • Brain or nerves Muscular • Medical causes Cord pathology - A multitude

  25. RLN pathologies • Brain nucleus ambiguus: stroke + HI • Other neurological problems

  26. RLN pathologies • Neck lesions

  27. RLN pathologies • Neck lesions Tumour Trauma

  28. Cord Causes Surgical Sieve: Congenital - laryngeal abnormalities - neurological abnormalities Acquired…

  29. Inflammatory / infective • Laryngitis - infective - chemical (GORD) • Supraglottitis • Pharyngitis

  30. Traumatic • Direct trauma

  31. Traumatic • nodules

  32. Traumatic • Chronic trauma to cords (vocal nodules)

  33. Traumatic

  34. Granulomata • Intubation • Trauma • Chronic inflammation • GORD • Throat clearing

  35. Granulomata • Intubation • Trauma • Chronic inflammation

  36. Granulomata • Treatment usually conservative • Treat causes • Medical: treat causes • SpTp • Surgical: excision +/- bx.

  37. Neoplastic Benign

  38. Neoplastic Malignant

  39. Voice abuse / smoking Reinke’s Oedema Submucosal oedema of the cords

  40. Radiation injury • Post radiotherapy dysphonia Cords injured Surrounding structures distorted

  41. Summary • Common complaint • Needs urgent evaluation • Assess entire pathway to cords • Low threshold for ML

  42. Any questions about hoarse people?

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