|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.
|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.
|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.
|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.
|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).
|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.
|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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