hoarsneess

Question 1

what is hoarseness defined as ?

Answer 1

any change in the quality of human voice

Question 2

what are the general causes associated with hoarseness ?

Answer 2

congenital
inflammatory
mucosal fold disorders
neoplastic
premalignant
neurological
miscellaneous
endocrine
aging

Question 3

what are the congenital causes of hoarseness ?

Answer 3

laryngeal webs
vocal cord paralysis

Question 4

what is the pathology in laryngeal webs ?

Answer 4

incomplete canalization of the laryngeal lumen

Question 5

what is the clinical picture associated with laryngeal wbs ?

Answer 5

asymptomatic or weak hoarse cry
stridor if the web is large in size

Question 6

what is the treatment for laryngeal webs ?

Answer 6

no treatment required if asymptomatic
microlaryngeal surgery
tracheostomy if the airway is compromised

Question 7

what are the inflammatory causes of hoarseness ?

Answer 7

acute laryngitis
croup
chronic non specific laryngitis
chronic specific laryngitis
acute epiglottitis

Question 8

which of the inflammatory causes of hoarseness is the commonest ?

Answer 8

acute laryngitis

Question 9

what are the causes of acute laryngitis ?

Answer 9

post upper respiratory tract infection
viral causes include: parainfluenza, influenza, rhinovirus
bacterial causes : strep pneumonia

Question 10

what is the clinical picture of acute laryngitis ?

Answer 10

general manifestation : fever, headache and malaise
hoarseness
discomfort and pain on phonation
dry cough
mucopurulent discharge
difficulty in breathing in severe cases

Question 11

what is the treatment for acute laryngitis ?

Answer 11

humidification
rest
pain management
mucolytics
antibiotics

Question 12

what is the presentation of acute epiglottitis ?

Answer 12

general manifestations - ill
muffled hot potato voice
rapid progressive stridor

Question 13

what is the management for acute epiglottitis ?

Answer 13

as acute laryngitis
along with proper airway management

Question 14

why is acute epiglottitis not commonly seen anymore ?

Answer 14

due to Hib vaccine

Question 15

what is the presentation of croup ?

Answer 15

seal like barking cough

Question 16

what is the causative organism in croup ?

Answer 16

parainfluenza virus

Question 17

what is the presentation of chronic nonspecific laryngitis ?

Answer 17

GERD due to chronic irritation
heartburn
globus sensation
regurgitation
night breakthrough

Question 18

what are the mucosal fold disorders causing hoarseness ?

Answer 18

vocal cord nodules or singers nodules
vocal cord polyps
vocal cord cysts
Reinke’s oedema

Question 19

what is the gross picture of vocal cord nodules ?

Answer 19

sessile nodules
medial edge of vocal cord
at the junction of ant 1/3 and post 2/3
pinkish in early stage - white in late stage

Question 20

what is the pathology behind vocal cord nodules ?

Answer 20

epithelial hyperplasia

Question 21

what is the treatment for vocal cord nodules ?

Answer 21

excision by microlaryngeal surgery
along with voice therapy

Question 22

where are vocal cord polyps found ?

Answer 22

medial edge or undersurface of vocal cords
at the junction of ant 1/3 and post 2/3

Question 23

what is the pathology in vocal cord polyps ?

Answer 23

localized subepithelial oedema with vascular engorgement

Question 24

what is the treatment for vocal cord polyps ?

Answer 24

excision by microlaryngeal surgery
along with voice therapy

Question 25

what is reinke's space ?

Answer 25

superficial lamina propria of the vocal ligament a potential space

Question 26

how does reinke's oedema happen ?

Answer 26

accumulation of fluid due to chronic irritation

Question 27

what is the main cause of reinke's oedema ?

Answer 27

irreversible swelling of the vocal cords mainly due to chronic heavy smoking

Question 28

what are the benign neoplastic causes of hoarseness ?

Answer 28

Recurrent respiratory papillomatosis

Question 29

what is the causative organism of Recurrent Respiratory papillomatosis ?

Answer 29

Human papillomavirus

Question 30

what is the treatment of recurrent respiratory papillomatosis ?

Answer 30

CO2 ablation high incidence of recurrence

Question 31

what are the premalignant causes of hoarseness ?

Answer 31

leukoplakia

Question 32

what is the pathology behind leukoplakia ?

Answer 32

epithelial hyperplasia and hyperkeratinization due to chronic irritation

Question 33

what is the presentation of leukoplakia ?

Answer 33

whitish patch with irregular surface may occur as a single or multiple patches unilateral or bilateral affection

Question 34

what is the treatment for leukoplakia ?

Answer 34

excision by microlaryngeal surgery strict follow up

Question 35

what are the malignant causes of hoarseness ?

Answer 35

laryngeal carcinoma ( sq cell carcinoma )

Question 36

what aree the neurological causes of hoarsness ?

Answer 36

bilateral vocal cord paralysis

Question 37

what is the presentation of bilateral vocal cord paralysis ?

Answer 37

weak breathy voice

Question 38

what are the causes of bilateral vocal cord paralysis ?

Answer 38

thyroid surgery trauma mediastinal mass

Question 39

which nerves are more likely to be affected in thyroid surgery and in mediastinal masses ?

Answer 39

thyroid surgery : recurrent laryngeal surgery Mediastinal mass : left vocal cord paralysis

Question 40

what is the diagnosis of a patient that complains of dysphonia without any obvious anatomical, neurological or other organic causes affecting the larynx ?

Answer 40

muscle tension dysphonia or functional dysphonia

Question 41

what are the types of functional dysphonia ?

Answer 41

hypofunctional dysphonia - incomplete closure of the vocal cords hyperfunctional dysphonia - overuse of the laryngeal muscles and occasionally use of the false vocal cords

Question 42

what is the treatment of muscle tension dysphonia ?

Answer 42

voice therapy

Question 43

what are the endocrine causes of dysphonia ?

Answer 43

hypothyroidism hormonal disturbances

Question 44

dysphonia due to aging ?

Answer 44

presbylaryngis or presbyphonia

Question 45

what are the red flags that come with hoarseness ?

Answer 45

history of smoking or alcohol use concomitant neck mass unexplained weight loss accompanying neurological symptoms accompanying haemoptysis, dysphagia,odynophagia,otalgia hoarseness that is persistent or worsening

Question 46

what investigations can be performed for a case of hoarseness ?

Answer 46

flexible nasoendoscopic examination of the larynx appropriate blood tests CT scan of the neck +/- mediastinal masses

Question 47

misuse of voice can lead to -

Answer 47

vocal cord polyps nodules or cysts

Question 48

excessive smoking can lead to ?

Answer 48

leukoplakia Reinke's oedema laryngeal cancer

Question 49

what endocrinal disorder is associated with reinke's oedema ?

Answer 49

hypothyroidism

Question 50

what does it mean when the vocal cord is in a paramedian position ?

Answer 50

recurrent laryngeal nerve paralysis

Question 51

what are the red flags associated with hoarseness that require urgent ENT referral ?

Answer 51

cachexia hemoptysis , dysphagia weight loss persistent hoarseness for more than 3 weeks accompanying neurological symptoms neck mass