STUDY - Technical - New Dacian's Medicine
Hoarseness
(Classical / Allopathic Medicine)
Hoarseness - a
rough or harsh sound to the voice - can result from an
infection or inflammatory lesion or exudate of the larynx,
from laryngeal edema, or from compression or disruption of the
vocal cords or recurrent laryngeal nerve. This common sign can
also result from a thoracic aortic aneurysm, vocal cord
paralysis, or a systemic disorder, such as Sjögren's syndrome
or rheumatoid arthritis. It's characteristically worsened by
excessive alcohol intake, smoking, inhalation of noxious
fumes, excessive talking, and shouting.
Hoarseness can be
acute or chronic. For example, chronic hoarseness and
laryngitis result when irritating polyps or nodules develop on
the vocal cords. Gastroesophageal reflux into the larynx
should also be considered as a possible cause of chronic
hoarseness. Hoarseness may also result from progressive
atrophy of the laryngeal muscles and mucosa due to aging,
which leads to diminished control of the vocal cords.
HISTORY:
Ask the patient about the onset of hoarseness.
Ask the patient if he has been overusing his voice; has experienced shortness of breath, a sore throat, dry mouth, or a cough; or has had difficulty swallowing dry food. In addition, ask if he has been in or near a fire within the past 48 hours.
Explore associated symptoms, and review the patient's medical history for cancer, rheumatoid arthritis, and an aortic aneurysm.
Ask the patient if he regularly smokes or drinks alcohol.
Ask the patient about the onset of hoarseness.
Ask the patient if he has been overusing his voice; has experienced shortness of breath, a sore throat, dry mouth, or a cough; or has had difficulty swallowing dry food. In addition, ask if he has been in or near a fire within the past 48 hours.
Explore associated symptoms, and review the patient's medical history for cancer, rheumatoid arthritis, and an aortic aneurysm.
Ask the patient if he regularly smokes or drinks alcohol.
PHYSICAL
ASSESSMENT:
Inspect the oral cavity and pharynx for redness or exudate, possibly indicating an upper respiratory tract infection.
Palpate the neck for masses and the cervical lymph nodes and the thyroid for enlargement.
Palpate the trachea. (Is it midline?)
Ask the patient to stick out his tongue; if he can't, he may have paralysis from cranial nerve involvement.
Examine the eyes for corneal ulcers and enlarged lacrimal ducts (signs of Sjögren's syndrome).
Assess the patient for dilated neck and chest veins.
Take the patient's vital signs, noting especially fever and bradycardia.
Assess the patient for asymmetrical chest expansion or signs of respiratory distress, such as nasal flaring, stridor, and intercostal retractions.
Auscultate for crackles, rhonchi, wheezing, and tubular sounds, and percuss for dullness.
Inspect the oral cavity and pharynx for redness or exudate, possibly indicating an upper respiratory tract infection.
Palpate the neck for masses and the cervical lymph nodes and the thyroid for enlargement.
Palpate the trachea. (Is it midline?)
Ask the patient to stick out his tongue; if he can't, he may have paralysis from cranial nerve involvement.
Examine the eyes for corneal ulcers and enlarged lacrimal ducts (signs of Sjögren's syndrome).
Assess the patient for dilated neck and chest veins.
Take the patient's vital signs, noting especially fever and bradycardia.
Assess the patient for asymmetrical chest expansion or signs of respiratory distress, such as nasal flaring, stridor, and intercostal retractions.
Auscultate for crackles, rhonchi, wheezing, and tubular sounds, and percuss for dullness.
SPECIAL
CONSIDERATIONS:
Carefully observe the patient for stridor, which may indicate bilateral vocal cord paralysis. Be aware that inhalation injury can cause sudden airway obstruction.
When hoarseness lasts longer than two weeks, indirect or fiber-optic laryngoscopy is indicated to observe the larynx at rest and during phonation.
Carefully observe the patient for stridor, which may indicate bilateral vocal cord paralysis. Be aware that inhalation injury can cause sudden airway obstruction.
When hoarseness lasts longer than two weeks, indirect or fiber-optic laryngoscopy is indicated to observe the larynx at rest and during phonation.
PEDIATRIC
POINTERS:
In children, hoarseness may result from congenital anomalies, such as laryngocele and dysphonia plicae ventricularis.
In prepubescent boys, hoarseness can stem from juvenile papillomatosis of the upper respiratory tract.
In infants and young children, hoarseness commonly stems from acute laryngotracheobronchitis (croup).
Temporary hoarseness frequently results from laryngeal irritation due to the aspiration of liquids, foreign bodies, or stomach contents.
In children, hoarseness may result from congenital anomalies, such as laryngocele and dysphonia plicae ventricularis.
In prepubescent boys, hoarseness can stem from juvenile papillomatosis of the upper respiratory tract.
In infants and young children, hoarseness commonly stems from acute laryngotracheobronchitis (croup).
Temporary hoarseness frequently results from laryngeal irritation due to the aspiration of liquids, foreign bodies, or stomach contents.
PATIENT
COUNSELING:
Stress to the patient the importance of resting his voice. Talking - even whispering - further traumatizes the vocal cords. Suggest other ways to communicate, such as writing or using body language. Urge the patient to avoid alcohol, smoking, and exposure to secondhand smoke.
Stress to the patient the importance of resting his voice. Talking - even whispering - further traumatizes the vocal cords. Suggest other ways to communicate, such as writing or using body language. Urge the patient to avoid alcohol, smoking, and exposure to secondhand smoke.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)