Hoarse Voice

Hoarse Voice

DEFINITION

Any change in voice tone with a harsh or noisy quality. It is the most important symptom of laryngeal diseases.

WHEN SHOULD IT BE ASSESSED?

Any hoarseness persisting for more than 15 days without evidence of infection, requires complete testing

NORMAL VOICE PRODUCTION

Sound is produced during exhalation. The airflow from the lungs makes the vocal cords vibrate.
A normal voice requires a normal lower and upper respiratory tract, and glottis.

ASSESSMENT OF PATIENT WITH HOARSENESS

It includes:
THOROUGH HISTORY-TAKING concerning the duration of symptoms, whether their appearance is acute or progressive, whether they are intermittent or persistent, their progressiveness and voice variations throughout the day. It is important to investigate whether there is a history of allergic rhinitis, previous operations that jeopardise the laryngeal nerve, injuries due to intubation or hypothyroidism. It is also significant to check whether there are accompanying symptoms such as pain, ear pain, cough, dysphagia, or aggravating routines and habits: use of alcohol or tobacco, voice abuse, profession.

CLINICAL EXAMINATION

, which includes testing the nose, pharynx and larynx with a flexible nasopharyngolaryngoscope, testing the vocal cords by stroboscopy, ear-hearing tests, neck palpation.

CAUSES OF HOARSENESS

These may be many, from a common cold to a malignancy.

INFLAMMATIONS

Laryngitis due to gastroesophageal reflux, allergic laryngitis, sarcoidosis,
Wegener’s granulomatosis, rheumatoid arthritis, polychondritis

INFECTIONS

Viral laryngitis, bacterial laryngitis, tuberculous laryngitis, fungal laryngitis

VOCAL CORD PARESIS

Due to tumours, trauma, aortic arch aneurysms, after intubation, cerebrovascular diseases, postoperative or idiopathic.

SURGICAL PROCEDURES ENTAILING A RISK OF LARYNGEAL NERVE INJURY

Χειρουργικές επεμβάσεις στις καρωτίδες, Surgery on the carotids, cervical lymph node ablation, cardiac surgery, Surgery on the mediastinum, trachea, Thymectomy

INJURY OF THE LARYNX

Haematoma, swelling, fracture of the cartilage of the laryngeal skeleton, disarticulation

MISCELLANEOUS CAUSES

Reinke’s oedema, hypothyroidism, medications/cocaine, cysts, psychological causes

LARYNGEAL NEOPLASMS

Vocal cord polyps, vocal cord nodules, papillomas, haemangioma, paraganglioma, schwannoma, chondroma, squamous cell carcinomas, other carcinomas and sarcomas, primary malignant lymphoma, metastatic tumours

LARYNGEAL PAPILLOMA

Depending on the localisation, supraglottic, glottic, subglottic, transglottic

SUPRAGLOTTIC CANCER

It usually manifests with foreign body sensation and difficulty in swallowing, often with cervical lymph node swelling, increased sputum-bloody sputum-bad breath. Hoarseness rarely appears as the first manifestation.

GLOTTIC CANCER

The earliest symptom is hoarseness. Other symptoms are persistent, irritating cough and pain as a late symptom due to cartilage filtration.
Shortness of breath and wheezing occur in very advanced stages

SUBGLOTTIC CANCER

It manifests with hoarseness due to infiltration of the vocal cord and dyspnoea due to narrowing of the lumen of the larynx.

DIAGNOSIS OF LARYNGEAL CANCER

The basic examination for setting the diagnosis is laryngeal endoscopy; imaging tests with a CT and/or magnetic resonance imaging of the neck may also often be necessary.

LARYNGEAL CANCER TREATMENT

Initially, the patient must undergo microlaryngoscopy-biopsy of the suspect lesion, to confirm the diagnosis of cancer histologically. It can be treated by surgery (conventional or using a CO2 laser), radiotherapy, chemotherapy or combinations thereof.

BENEFITS OF LARYNGEAL CANCER TREATMENT USING CO2 LASER

Diagnosis and treatment at the same time, avoidance of tracheostomy, low perioperative morbidity, shorter hospitalisation, less disruption of swallowing
Furthermore, satisfactory or very good voice quality, lower cost of radiotherapy, preservation of thyroid cartilage, which functions as a barrier in the case of cancer recurrence.

INDICATIONS FOR ENDOSCOPIC SURGERY WITH CO2 LASER

The ideal indication is early glottic cancers
In addition, superficial lesions in the supraglottic and subglottic region