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Hoarseness Notes

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This is an extract of our Hoarseness document, which we sell as part of our ENT Notes collection written by the top tier of University Of Leicester students.

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Hoarseness What is a normal voice?One that is o Audible in a wide range of acoustic settings o Appropriate for gender and age o Capable of fulfilling its linguistic and paralinguistic functions o Not easily fatigued o Not associated with phonatory discomfort/pain

PathophysiologyVocal cords are attached anteriorly to the thyroid cartilage and posteriorly to the arytenoid cartilages Intrinsic laryngeal muscles abduct cords for respiration and adduct the cords for lower airway protection, cough and phonation Vocal cords = mucosal folds o Have a superficial layer of epithelium separated from the underlying ligament and muscle by 'reinke's space'
? Allows epithelial layer to slide and osscilate passively over the ligament

Larynx is divided into three regionsSupraglottis Glottis Subglottis

AetiologyVoice into o o o o

problems can be classified Structural/neoplastic Inflammatory Neuromuscular Muscle tension imbalance

Patients may have evidence of >1 E.g a vocal cord polyp (structural) may arise as a result of a primary muscle tension from voice abuse during a viral URTI (inflammation)

ReferalAs a laryngeal visualization is often necessary, most patients need referring Patients with persistent hoarseness/voice change for > 3 weeks (especially if a smoker, heavy drinker + >40 years) need urgent CXR to exclude RLN palsy from lung cancer + referral to ENT surgeons

AssessmentHistory o Specific voice problem e.g abnormal quality, pitch etc o Onset, duration o Constant/intermittent o Relieving/exacerbating factors o Voice requirement e.g fine precision + control/voice projection/continuous use o Past medical history o Drug history - reduced laryngeal secretions + mucosal drying =
anticholinergics, diuretics. Irritant = bronchial inhalers

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