Hoarseness (½®¼Ò¸®)

The Root of Ambulatory Care
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KEYWORDS:
..A change in normal voice quality or abnormal production of sound by the larynx.
< Causes of hoarseness >
Acute hoarseness : less than 2weeks (usually benign)
..Vocal overuse and abuse : common cause of edema and erythema of the vocal
cords. (e.g., Singers, Speakers)
..Hemorrhage into a vocal fold secondary to voice trauma (e.g., Yelling)
..Viral laryngitis : associated with a sore throat (Coxsackie, EB, influenza A, Variola, Echo,
Parainfluenza and herpes simplex viruses etc)
..Bacterial laryngitis : Moraxella catarrhalis, Haemophilus influenza, Streptococcus,
Staphylococcus, Mycoplasma and Pneumococcus etc
..Chemical and environmental irritants : exposure to certain allergens or irritating agents
can cause edema and erythema similar to that seen with infectious agents.
(e.g., Cigarette smoking)
Chronic hoarseness : more than 2weeks (suggests a more serious conditions,
requires evaluation)
..Benign : Nodules, Polyps, Callus formation, Papillomas (Nodules can resolve with
proper therapy ; but all others require surgery)
..Malignant : Squamous cell cancer (predisposing factors : smoking/alcohol abuse)
Other Causes
..GERD : direct irritation
..Immobility of one or more vocal cords : result from injury to the recurrent laryngeal
nerves (e.g., surgery, central neurologic lesions, intubation, lung cancer, left atrial
enlargement)
..Systemic diseases : Hypothyroidism (causes edema of the vocal cord), Wegener's
granulomatosis, amyloidosis, lupus, RA, sarcoidosis
Hoarseness
..Pregnancy : increased blood volume and swelling of the vocal cord.
..Presbylaryngeus : most common in elderly (decreased muscle tone causes the vocal
cords bow)
..Neurologic diseases : DM, Parkinson's disease, Amyotrophic lateral sclerosis,
Guillain-Barre syndrome etc
1. Less than or greater 2 weeks?
2. Sometimes the voice is normal?
¡æ Fixed lesion do not allow that.
3. Fluctuate during the day?
¡æ GERD causes hoarseness more in the morning.
4. Otalgia?
¡æ Infection?
5. Medical history
¡æ allergen/surgery/intubation/any other systemic disease (hypothyroidism)
6. Smoker/heavy drinker?
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Carotid surgery
Neck dissection for head and neck cancer
Cardiac surgery
Patent ductus ligation
Valve repair
Mediastinal surgery
Thymectomy
Mediastinoscopy
Esophagectomy
Thyroid surgery
Anterior cervical disc surgery
359
The Root of ambulatory care
Key questions
Key treatments
Hoarseness
Tracheal surgery
Tracheal reconstrucion
..Horseness Æò°¡¿¡ °¡Àå Áß¿äÇÑ ºÎºÐÀº LaryngoscopeÀ¸·Î Á÷Á¢ larynx¸¦ °üÂû
ÇÏ´Â °ÍÀÌ´Ù.
¢º Vocal polyp ¢º Diffuse polyp : ¼ö¼ú ÀüÈÄ
¢º Vocal nodule (Singer's nodule) ¢º Laryngeal cancer
- Good vocal hygiene
1. Vocal rest but not total disuse
(if due to vocal overuse or trauma)
2. Hydration
(six-eight glasses of water/day but alcohol and caffeine should be avoided as
they cause diuresis and therefore mild dehydration.)
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The Root of ambulatory care
3. Things to avoid
- Breathing foul air
- Using tobacco or marijuana
- Using drugs
- Drinking alcohol
- Shouting at sporting events
- Trying to be heard in noisy places like bars or airports
- Making sounds while yawning
- Clearing throat continually
- Trying to talk over a cold or laryngitis
- Whispering loudly or for very long
- Trying to change natural speaking voice
Substances that can cause problems in the larynx include : cigarettes, marijuana,
coffee(dehydration), antihistamine(drying effect), tricyclic antidepressants(drying effect)
and steroids.
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Clark A. Rosen, M.D., Deborah Anderson, M.D., Thomas Murry, PhD. : Evaluating Hoarseness :
Keeping Your Patient's Voice Healthy. A journal of the American Family Physicains 1998;57(11):2775-
2788
William A. Schwer : Hoarseness, in Saunders Manual of Medical Practice, 2nd ed, Robert E. Rakel(ed).
Philadelphia, Saunders, 2000, P 83-85
Â÷Çü¼ö : ½® ¸ñ¼Ò¸®, in °¡Á¤ÀÇÇÐ ÀÓ»óÆí. ¼¿ï, °èÃø¹®È»ç, 2002, P 738-743
¾Èȸ¿µ : ÃÖ½ÅÀÓ»óÀ̺ñÀÎÈİú. ¼¿ï, ±ºÀÚÃâÆÇ»ç, 2005, P 205, P210