Hoarseness is defined as roughness of voice resulting from variation of periodicity and/ or intensity of consecutive sound waves.
After taking history following information are obtained. Age- 65 years.
Aggregating factors- smoking, alcoholism etc.
In this case probable causes of hoarseness may be-
a. Acute laryngitis usually following cold, influenza, exanthematous fever.
Non-specific: Chronic laryngitis without hyperplasia, chronic laryngitis with hyperplasia.
Specific: Tuberculosis, syphilis, scleroma.
2. TUMOUR BENIGN: Papilloma (solitary & multiple), haemangioma, chondroma, fibroma, leukoplakia.
3. TUMOUR LIKE MASS: Vocal cord nodule, vocal polyp, Reinkies oedema, contact ulcer, cyst, laryngocele.
4. MALIGNANT: Laryngeal CA.
5. PARALYSIS: Paralysis of recurrent laryngeal, superior laryngeal or both nerve.
Mode of onset.
Duration of illness- >3 weeks deserves examination of larynx.
Malignancy should be excluded >40 years.
2. INDIRECT LARYNGOSCOPY: Local laryngeal causes.
3. EXAMINATION OF NECK, CHEST, CVS, & NEUROLOGICAL SYSTEM: To find out cause of laryngeal paralysis.
4. LABORATORYINVESTIGATION & RADIOLOGY: To know the cause, suspected of clinical examination.
5. DIRECT LARYNGOSCOPY & MICROLARYNGOSCOPY: Help in detailed examination, biopsy of lesion & assessment of the mobility of cricoarytenoid joint.
6. BRONCHOSCOPY & OESOPHAGOSCOPY: In case of paralytic lesion of the cord to exclude malignancy.
LABORATORY INVESTIGATION & RADIOLOGICAL EXAMINATIONS SHOULD BE DONE TO EXCLUDE-
A. X-Ray chest- To exclude tuberculous cause.
B. X-Ray PNS, nasal endoscopy- To rule out malignancy.
C. Supravital staining with Toludine blue- Helps to detect laryngeal carcinoma & keratosis larynx.
D. Direct laryngoscopy with biopsy- For laryngeal carcinoma.
E. Videostroboscopy: speed of vibration of vocal fold usually over 100 cycles per. It is important for diagnosis of- Laryngeal paralysis, very small early laryngeal cancer, completeness of glottic closure during phonation, vocal cord scarring, laryngeal cyst, laryngeal polyp, sulcus vocalis.
a. Avoidance of alcohol, smoking.
b. Voice rest.
c. Speech therapy.
d. Steam inhalation (laryngeal hydratis).
e. Maintain adequate vocal hygiene.
a. Analgesic to relief pain.
b. In case of TB- Anti- tubercular drug.
a. For vocal cord polyp- Micro laryngeal excision.
b. For Reinkei’s oedema- Reduction.
c. For vocal nodules- Micro laryngoscopy & precise excision.
d. For laryngeal nerve palsy- Laryngoplasty, Teflon injection, thyroplasty, epiglotoplexy, tracheostomy may be need for initial resuscitation of the patient.
e. For laryngeal CA- surgery with pre or post radiotherapy, conservative laryngeal surgery, total laryngectomy, Endoscopic CO2 laser excision.
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