Hoarseness

Abstract

H oarse voice, or dysphonia, is a common presenting complaint in primary care and an important source of patient morbidity. The underlying pathology can vary from benign to immediately life-threatening and structured clinical assessment is essential in differentiating causes and determining management. In this article, we discuss the clinical approach, aetiology and management of the wide range of conditions that lead to dysphonia and provide guidance on referral to specialist care. The GP curriculum and hoarseness Clinical module 3.15: Care of people with ENT, oral and facial problems states that GPs should be able to:. Manage primary contact with patients who have a common/important ENT, oral, or facial problem, e.g. vertigo or tinnitus. Demonstrate knowledge of the scientific backgrounds of symptoms, diagnosis and treatment of ENT, oral and facial conditions. Understand how to recognise rarer but potentially serious conditions such as oral, head and neck cancer. Understand when urgent (or semi-urgent) referral to secondary care may be indicated, e.g. in trauma, epistaxis, quinsy (peritonsillar abscess), severe croup or stridor. Understand when watchful waiting and the use of delayed prescriptions are indicated.. Demonstrate an evidence-based approach to antibiotic prescribing. Demonstrate effective strategies for dealing with parental concerns regarding ENT conditions. Understand and implement the key national guidelines that influence healthcare provision for ENT problems. Terminology Hoarseness can be broadly defined as altered vocal quality, pitch, loudness, or vocal effort that impairs verbal communication or reduces quality of life (Schwartz et al., 2009). Considerable variation exists in the use of the term, but it is generally accepted that hoarseness is a symptom with dysphonia being the corresponding medical diagnosis. It is often confused with disorders of articulation (dysarthria) that result from impaired neuromuscular control (e.g. cerebellar damage) of the mouth and tongue (Swanberg, Nasreddine, Mendez, & Cummings, 2007). Indeed, finding dysphonia in acute ear, nose and throat (ENT) presentations can indicate an often more serious laryngeal pathology.

The association of voice problems with exposure to indoor air contaminants in health care centres – the effect of remediation on symptom prevalence: A follow-up study

“…The pathophysiological mechanisms behind hoarseness remain partly obscure, but previous publications suggest that noise in the work environment, irritant gases, dust, respiratory infections, stomach problems and certain medical drugs may have an effect on the origin of hoarseness. 9,10 Our data supports the hypothesis that hoarseness is more often due to irritation of larynx than an allergic reaction. We found no significant correlation between hoarseness and sensitization to common aeroallergens, dust mites or moulds.…”

“…Allergies and atopy may trigger voice symptoms, also smoking and other irritant gases, fumes and particles may increase or worsen symptoms. 9,10 In dental care, many potentially harmful chemicals are used. In health care work, there is common exposure to pathogenic and other microbes, disinfectants and medical drugs.…”