|Acute viral laryngitis||Viral URTI preceding aphonia +/− of sore throat.||Bilateral vocal cord edema and erythema.||Improves usually with resolution of URTI Conservative treatment with voice rest.||Antibiotic if 2° bacterial infection. Most common infectious cause of hoarseness.|
|Vocal cord nodules||Occurs more frequently in singers, females and children. Aggravated by URTI, sinusitis, smoke and alcohol.||Often arise bilaterally at the junction of the anterior and middle 1/3 of the vocal cords. Soft and red, but chronic nodules become fibrotic, hard and white.||Voice rest. Speech therapy. Rarely is surgery ever indicated.||Caused by sub mucosal inflammation.|
|Laryngitis 2° to GERD||Hx of GERD and its precipitating factors.||Erythema and edema of the mucosa lining the arytenoids, may develop ulcers or granulomas in a similar distribution.||Treatment as for reflux conservative vs. medications vs. surgery.|
|Vocal cord polyp||Males, smokers, vocal misuse or abuse or irritant exposure +/- dyspnea, cough.||Unilateral, asymmetric, broad based and pedunculated with a smooth, soft appearance (can occur bilaterally).||Voice rest. Speech therapy. Surgical excision.||The diffuse form is called Reinke’s edema, which is due to fluid accumulation in the loose submucosal space.|
|Squamous papillomas||Often occur at the anterior commisure and true vocal cord subglottic and supraglottic areas may be involved. Appears as white to reddish verrucous mass.||complete surgical excision/laser extirpation.||Most common benign tumor.|
|Glottic carcinoma||Predisposing factors: alcohol, smoking, exposure to radiation, HPV and nickel exposure Symptoms include dysphagia, odynophagia, otalgia and hemoptysis.||Lesions will vary in appearance dysplasia or CIS may appear as leukoplacia, Often exophytic, ulcerated growth on vocal cord membrane.||Due to poor lymphatic supply tumor spread at time presentation is not common.||Refer to otolaryngologist. Biopsy. Organ preservation therapy: Radiation therapy or surgery.|
|Psychogenic||Patient will complain of only being able to speak in forced whisper.||Normal cough Ability of patient to say ‘Ah’ in their normal voice.||A conversion disorder.|
|Spastic dysphonia||Strained, strangled voice associated with facial grimacing, during singing, crying or laughing the voice is normal. In some onset is related to major life stressor.||Hyper adduction of the true and false cords.||Botulinum toxin injection. Speech therapy (work if it is psychogenic in nature as opposed to neurological).|
|Cord paralysis||Breathy voice due to air escape – Bilateral paralysis may lead to airway compromise. Hx of recurrent laryngeal nerve damage (thyroid or CV surgery or disease).||Unilateral: Cord abducted in resting position and unable to adduct during phonation.
Bilateral: cords adducted, unable to abduct with little space between.
|Unilateral: Manage expectantly, or thyroplasty surgery where the paralyzed cord is medialized. Bilateral – Often needs a temporary trach.|
|Trauma||Hx of trauma to the larynx. Traumatic induced lesions of the vocal cord 2° to voice abuse (screaming, excessive singing without proper training).||Severe trauma can result in fracture, dislocation etc. trauma due to vocal abuse results in benign vocal cord polyps, nodules or contact granulomas.||Treatment depends upon the type of injury and treatment as above for polyps and nodules external trauma may require airway control, and surgery.||With external trauma assess larynx mucosa, cartilage and joints.|
Differential Diagnosis of Throat Problems
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