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HOARSENESS IN VOICE noor majeed rehani

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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HOARSENESS IN VOICE noor majeed rehani

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    1. HOARSENESS IN VOICE noor 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

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