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Hoarseness (½®¼Ò¸®)

The Root of Ambulatory Care (¿Ü·¡ Áø·á Áöħ¼­) Àüü ¸ñ·Ï º¸±â
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? ´ã¹è¿Í À½ÁÖ°æ·ÂÀÌ ÀÖ´Â Áß³âȯÀÚÀÇ ¸¸¼ºÁõ»óÀº ¾Ç¼ºÁ¾¾çÀ» ¹Ýµå½Ã ¹èÁ¦ÇÏ¿©¾ß ÇÑ´Ù. 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.) 361 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. ..¸ñ¼Ò¸®¸¦ ¼Ó»èÀ̵íÀÌ ³»´Â °ÍÀº ¼º´ë¿¡ ±äÀå°¨À» ÁÖ°ÔµÇ¾î º¸Åë ¸»ÇÏ´Â °Í º¸´Ù ´õ ³ª»Ú´Ù. Âü°í ¹®Çå 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