Hoarseness

Overview
Dysphonia is the medical term for hoarseness or other phonation disorders. It is considered much less severe than aphonia. Hoarseness can be a change in pitch, a rough sound of the voice, or an increased effort in speaking.
 * Acute hoarseness has a sudden onset and lasts fewer than 2 weeks
 * Chronic hoarseness lasts longer than 2 weeks

Classificaiton of Dysphonia

 * Organic dysphonia
 * Functional dysphonia
 * Spasmodic dysphonia

Differential Diagnosis
In alphabetical order.

Acute

 * Acute viral laryngitis
 * Aortic aneurysm
 * Aortic dissection
 * Anaphylaxis
 * Bacterial tracheitis / laryngitis
 * Cerebrovascular accident (CVA)
 * Chorditis
 * Croup
 * Deep space face and neck infection
 * Epiglottitis
 * Foreign body
 * Head injury
 * Laryngitis
 * Laryngotracheobronchitis
 * Overstress of vocal cords (speaking, shouting, singing, crying)
 * Sinusitis
 * Smoke irritation
 * Surgery
 * Trauma
 * Upper Respiratory Infection

Chronic

 * Aging
 * Allergic Rhinitis
 * Amyloidosis
 * Amyotrophic Lateral Sclerosis
 * Aortic aneurysm
 * Bronchial carcinoma
 * Bronchogenic tumor
 * Chondromas
 * Chronic cough, severe cold
 * Chronic inhalation of chemical irritant agents (professional activity)
 * Chronic sinusitis
 * Drugs
 * Edema of vocal cords
 * Esophageal tumor
 * Excessively dry and warm room coupled with low water intake
 * Foreign body
 * Gastroesophageal Reflux Disease (GERD)
 * Glomus jugulare tumor
 * Guillain-Barre Syndrome
 * Habitual aphonia
 * Hemangioma
 * Hemorrhage into vocal folds
 * Hypothyroidism
 * Juvenile dermatomyositis
 * Laryngeal papillomatosis
 * Laryngocelesventricular prolapse
 * Laryngeal carcinoma
 * Left atrial enlargement
 * Lipoma
 * Lung cancer
 * Menopause
 * Multiple Sclerosis
 * Muscular Dystrophy
 * Myasthenia Gravis
 * Neural tumor
 * Neurofibroma
 * Papillomas
 * Parkinson's Disease
 * Postsurgical
 * Psychogenic aphonia
 * Puberty
 * Reinke's Edema
 * Retention cysts
 * Rheumatoid Arthritis
 * Sarcoidosis
 * Spastic dysphonia
 * Squamous Cell Carcinoma
 * Systemic Lupus Erythematosus
 * Thyroid tumor
 * Ventricular dysphonias
 * Virilization
 * Vocal cord nodules
 * Vocal fold cyst
 * Vocal cord paralysis
 * Vocal cord polyps
 * Wegener's Granulotomosis

History and Symptoms
The following should be characterized as part of a full history:
 * Onset
 * Duration
 * Prior history
 * Exposure
 * Medications
 * Voice use
 * Associated symptoms
 * Medical history
 * Surgical history
 * Trauma

Physical Examination

 * Focus on neck, head, lung, thyroid and cardiac exams
 * Evaluate voice quality

Laboratory Findings

 * Thyroid function tests to rule out hypothyroidism

X-Ray

 * Chest X-ray
 * Lateral neck X-ray

MRI and CT

 * CT scan of sinuses
 * CT scan of head and neck

Other Diagnostic Studies

 * Upper gastrointestinal (GI) endoscopy
 * Direct or fiber optic nasolaryngoscopy
 * Biopsy

Treatment

 * Airway, breathing and circulation
 * Voice rest
 * Diet modification (GERD)
 * Stop smoking
 * Wear protective clothing or masks (if hoarseness is due to exposure)
 * Treat underlying etiologies
 * Voice therapy

Acute Pharmacotherapies

 * Antibiotics
 * Oral steroids
 * H2 blocker
 * Proton pump inhibitors
 * Intranasal steroids
 * Antihistamines

Surgery and Device Based Therapy

 * Surgical intervention for abscesses, masses
 * Cricothyrotomy or tracheostomy (to establish airway)