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Hoarseness results from imperfect phonation due to impairment of normal vocal cord mobility or vibration. It is an important symptom as it may signal a serious cause such as malignancy or a disease with potential for airway obstruction.1
RAYMOND L CARROLL 1996
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Hoarseness (dysphonia) is defined as an altered voice due to a laryngeal disorder.2 It is an important symptom of laryngeal disease presenting in general practice, and ranges from the very common, trivial, self-limiting condition of viral upper respiratory tract infection to a life-threatening disorder (see TABLE 57.1). It may be of sudden presentation lasting only a few days or develop gradually and persist for weeks or months. The cut-off point between acute and chronic hoarseness is three weeks duration, by which time most self-limiting conditions have resolved. Hoarseness pertains to harsh, raspy, gravelly or rough tones of voice rather than pitch or volume. Rarely, hoarseness can be a functional or deliberate symptom referred to as ‘hysterical aphonia’.3 In this condition, patients purposely hold the cords apart while speaking.
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Key facts and checkpoints
In acute hoarseness, the diagnosis is usually obvious from the history alone. Examples include acute upper respiratory tract infection (URTI) or vocal overuse.
Think ‘hypothyroidism’ if unusual hoarseness develops.
Laryngeal cancer must be excluded if hoarseness persists for longer than 3 weeks in an adult. It can arise intrinsic or extrinsic to the vocal cords.
Intermittent hoarseness is invariably secondary to a benign disorder. Constant or progressive hoarseness suggests malignancy.
Non-malignant vocal cord lesions, which include polyps, vocal nodules, contact ulcers, granulomas, other benign tumours and leucoplakia, account for about half of all voice disorders.
In cases of chronic hoarseness the larynx must be visualised for diagnosis but the following are common:
Acute laryngeal oedema may develop as a ...