Dysphonia

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Dysphonia
ICD-10 R49.
ICD-9 784.49

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and Keywords: hoarseness

Overview

Dysphonia is the medical term for hoarseness or other phonation disorders. It is considered much less severe than aphonia. Hoarseness can be a change in pitch, a rough sound of the voice, or an increased effort in speaking.

Classificaiton of Dysphonia

Based Upon Chronicity

  • Acute hoarseness has a sudden onset and lasts fewer than 2 weeks
  • Chronic hoarseness lasts longer than 2 weeks

Based Upon Pathophysiology

Causes

Common Causes

Causes by Organ System

Cardiovascular Aortic aneurysm, Aortic dissection, Left atrial enlargement, Wegener's Granulotomosis
Chemical / poisoning Smoke irritation, Chronic inhalation of chemical irritant agents (professional activity)
Dermatologic Lipoid proteinosis
Drug Side Effect Axitinib, Botulinum toxin, Danazol, Dornase alfa, Gestrinone, Ixabepilone, Loratadine, Naltrexone, Oxcarbazepine, Pramipexole, Tobramycin
Ear Nose Throat Elongated styloid process
Endocrine Goitre, Growth hormone secreting pituitary adenoma, Hypothyroidism, Parathyroid carcinoma, Riedel thyroiditis, Thyroid carcinoma, Thyroid tumor, Virilization
Environmental Chronic inhalation of chemical irritant agents (professional activity)
Gastroenterologic Esophageal tumor, Gastroesophageal Reflux Disease (GERD), Oral submucous fibrosis, Oropharyngeal cancer
Genetic Diastrophic dwarfism, Distal myopathy 2, Lipoid proteinosis, Muscular dystrophy
Hematologic No underlying causes
Iatrogenic Postsurgical
Infectious Disease Acute viral laryngitis, ,Bacterial tracheitis / laryngitis Chronic sinusitis, Croup, Deep space face and neck infection, Epiglottitis, Laryngitis, Laryngotracheobronchitis, Paracoccidioidomycosis, Quinsy, Sinusitis, Tracheolaryngobronchitis, Upper Respiratory Infection , Laryngeal papillomatosis
Musculoskeletal / Ortho Diffuse idiopathic skeletal hyperostosis, Muscular dystrophy, Polymyositis, Diastrophic dwarfism, Distal myopathy 2, Myasthenia gravis, Juvenile dermatomyositis, Rheumatoid arthritis
Neurologic 10th cranial nerve disorder, 12th cranial nerve disorder, Acoustic neuroma, Amyotrophic lateral sclerosis, Bulbar palsy, Cerebral palsy, Cerebrovascular accident, Guillain-Barre syndrome, Laryngeal nerve palsy, Motor neuron disease, Multiple sclerosis, Myasthenia gravis, Neural tumor, Parkinson's disease, Posterior inferior cerebellar artery syndrome, Spasmodic dysphonia, Lipoid proteinosis, Neurofibroma, Vocal cord paralysis
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic Menopause
Oncologic Bronchial carcinoma, Bronchogenic tumor, Chondromas, Glomus jugulare tumor, Neurofibroma, Squamous cell carcinoma, Thyroid carcinoma, Thyroid tumor, Growth hormone secreting pituitary adenoma, Parathyroid carcinoma, Esophageal tumor, Acoustic neuroma, Neural tumor, Laryngeal carcinoma, Lung cancer, Oropharyngeal cancer, Hemangioma
Opthalmologic No underlying causes
Overdose / Toxicity Axitinib, Danazol, Dornase alfa, Gestrinone
Psychiatric Habitual aphonia, Psychogenic aphonia, Spasmodic dysphonia
Pulmonary Chorditis, Edema of vocal cords, Foreign body in respiratory tract, Hemangioma, Hemorrhage into vocal folds, Laryngeal carcinoma, Laryngeal granuloma, Laryngeal papillomatosis, Laryngocelesventricular prolapse, Laryngomalacia, Lipoma, Lung cancer, Nasal polyps, Oropharyngeal cancer, Papillomas, Reinke's edema, Retention cysts, Spasmodic dysphonia, Ventricular dysphonias, Vocal cord nodules, Vocal cord paralysis, Vocal cord polyps, Vocal fold cyst, Acute viral laryngitis, Bacterial tracheitis / laryngitis, Chronic sinusitis, Croup, Epiglottitis, Laryngitis, Laryngotracheobronchitis, Sinusitis, Tracheolaryngobronchitis, Upper Respiratory Infection , Bronchial carcinoma, Bronchogenic tumor, Squamous cell carcinoma, Allergic rhinitis, Chronic cough, severe cold, Sarcoidosis, Singer nodes
Renal / Electrolyte No underlying causes
Rheum / Immune / Allergy Allergic rhinitis, Anaphylaxis, Juvenile dermatomyositis, Rheumatoid arthritis, Rheumatoid disease, Riedel thyroiditis, Polymyositis, Amyotrophic lateral sclerosis, Guillain-Barre syndrome, Multiple sclerosis, Systemic lupus erythematosus, Sarcoidosis
Sexual No underlying causes
Trauma Head injury, Trauma
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Aging, Amyloidosis, Chronic cough, severe cold, Excessively dry and warm room coupled with low water intake, Overstress of vocal cords (speaking, shouting, singing, crying), Puberty, Sarcoidosis, Singer nodes, Systemic lupus erythematosus, Virilization, Smoke irritation, Menopause, Foreign body in respiratory tract

Causes in Alphabetical Order


In alphabetical order. [1] [2]

Acute

Chronic

Diagnosis

History and Symptoms

The following should be characterized as part of a full history:

  • Onset
  • Duration
  • Prior history
  • Exposure
  • Medications
  • Voice use
  • Associated symptoms
  • Medical history
  • Surgical history
  • Trauma

Physical Examination

  • Focus on neck, head, lung, thyroid and cardiac exams
  • Evaluate voice quality

Laboratory Findings

X-Ray

MRI and CT

Other Diagnostic Studies

  • Upper gastrointestinal (GI) endoscopy
  • Direct or fiber optic nasolaryngoscopy
  • Biopsy

Treatment

  • Airway, breathing and circulation
  • Voice rest
  • Diet modification (GERD)
  • Stop smoking
  • Wear protective clothing or masks (if hoarseness is due to exposure)
  • Treat underlying etiologies
  • Voice therapy

Pharmacotherapy

Acute Pharmacotherapies

Surgery and Device Based Therapy

  • Surgical intervention for abscesses, masses
  • Cricothyrotomy or tracheostomy (to establish airway)

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

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