Hoarseness (쉰소리)

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? → Fixed lesion do not allow that. 3. Fluctuate during the day? → GERD causes hoarseness more in the morning. 4. Otalgia? → Infection? 5. Medical history → allergen/surgery/intubation/any other systemic disease (hypothyroidism) 6. Smoker/heavy drinker? 담배와 음주경력이 있는 중년환자의 만성증상은 악성종양을 반드시 배제하여야 한다. 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 평가에 가장 중요한 부분은 Laryngoscope으로 직접 larynx를 관찰 하는 것이다. ▶ Vocal polyp ▶ Diffuse polyp : 수술 전후 ▶ Vocal nodule (Singer's nodule) ▶ 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. ..목소리를 속삭이듯이 내는 것은 성대에 긴장감을 주게되어 보통 말하는 것 보다 더 나쁘다. 참고 문헌 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 차형수 : 쉰 목소리, in 가정의학 임상편. 서울, 계측문화사, 2002, P 738-743 안회영 : 최신임상이비인후과. 서울, 군자출판사, 2005, P 205, P210