Hoarseness

Common causes: viral URTI (acute laryngitis), non-specific irritative laryngitis, vocal abuse, nodules and polyps of cords, intubation, oesophageal reflux. Chronic:

• children—‘screamer’s nodules’

• adults—non-specific laryngitis (e.g. smoking; ‘barmaid’ syndrome)

Exclude: imminent airway obstruction (e.g. croup, epiglottitis, malignancy, hypothyroidism), other severe infections (e.g. diphtheria, TB), foreign body, allergy, goitre. Also uncommon disorders Vocal Cord Dysfunction Syndrome and Excessive Dynamic Airways Collapse (‘floppy trachea’), both of which can mimic asthma.

Diagnosis: larynx must be visualised.

Investigations

• Thyroid function tests

• Chest X-ray—look for bronchogenic cancer

• Indirect laryngoscopy

• Direct laryngoscopy

• Consider CT scan for suspected laryngeal neoplasia or trauma

Management

• Acute:

  • – treat according to cause

  • – vocal rest or minimal usage at normal conversation

  • – avoid irritants (e.g. dust, tobacco, alcohol)

  • – consider inhalations and cough suppressants

• Chronic:

  • – establish diagnosis

  • – consider specialist ENT referral

Laryngitis, 339