Dysphonia
Synonyms and keywords: 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.

# Classificaiton of Dysphonia

## Based Upon Chronicity
- Acute hoarseness has a sudden onset and lasts fewer than 2 weeks
- Chronic hoarseness lasts longer than 2 weeks

## Based Upon Pathophysiology
- Organic dysphonia
- Functional dysphonia
- Spasmodic dysphonia

# Causes

## Common Causes
- Aging
- Cold
- Foreign body in respiratory tract
- Hypothyroidism
- Laryngitis
- Laryngeal cancer
- Overstress of vocal cords (speaking, shouting, singing and crying)
- Sinusitis
- Tracheitis

## Causes by Organ System

## Causes in Alphabetical Order
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

# Diagnosis

# 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

# Pharmacotherapy

## 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)