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  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-

1.  INFLAMMATIONS:

a.       Acute laryngitis usually following cold, influenza, exanthematous fever.

b.       Chronic:

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.

INVESTIGATION: 

1.       HISTORY:

Mode of onset.

Duration of illness- >3 weeks deserves examination of larynx.

Patient’s occupation.

Habits.

Associated complication.

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.

MANAGEMENT:

CONSERVATIVE TREATMENT:

a.       Avoidance of alcohol, smoking.

b.       Voice rest.

c.       Speech therapy.

d.       Steam inhalation (laryngeal hydratis).

e.       Maintain adequate vocal hygiene.

MEDICAL TREATMENT:

a.       Analgesic to relief pain.

b.       In case of TB- Anti- tubercular drug.

SURGICAL:

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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