Hoarseness is defined as roughness of voice resulting from variations of periodicity and\/or intensity of consecutive sound waves.<\/p>\n
<\/p>\n
For production of normal voice, vocal cords should:<\/p>\n
\u25a1 Be able to approximate properly with each other.
\n\u25a1 Have a proper size and stiffness.
\n\u25a1 Have an ability to vibrate regularly in response to air column. Any condition that interferes with these functions causes hoarseness.<\/p>\n
(a) Loss of approximation maybe seen in vocal cord paralysis or fixation or a tumour coming in between the vocal cords.<\/p>\n
(b) Size of the cord may increase in oedema of the cord or a tumour; there is a decrease in partial surgical excision or fibrosis.<\/p>\n
(c) Stiffness may decrease in paralysis, increase in spastic dysphonia or fibrosis. Cords may not be able to vibrate properly in the presence of congestion, submucosal haemorrhages, nodule or a polyp.<\/p>\n
INVESTIGATIONS<\/p>\n
\u25a1 History. Mode of onset and duration of illness, patient’s occupation, habits and associated complaints are important and would often help to elucidate the cause. Any hoarseness persisting for more than three weeks deserves examination of larynx. Malignancy should be excluded in patients above 40 years.<\/p>\n
\u25a1 Indirect laryngoscopy. Many of the local laryngeal causes can be diagnosed.<\/p>\n
\u25a1 Examination of neck, chest, cardiovascular and neurological system would help to find cause for laryngeal paralysis.<\/p>\n
\u25a1 Laboratory investigations and radiological examination should be done as per dictates of the cause suspected on clinical examination.<\/p>\n
\u25a1 Direct laryngoscopy and micro 1 aryngoscopy help in detailed examination, biopsy of the lesions and assessment of the mobility of cricoarytenoid joints.<\/p>\n
\u25a1 Bronchoscopy and oesophagoscopy may be required in cases of paralytic lesions of the cord to exclude malignancy.<\/p>\n
CAUSES OF HOARSENESS<\/p>\n
\u25a1 Inflammations
\nAcute : Acute laryngitis usually following cold, influenza, exanthematous fever, laryngo-tracheo-bronchitis, diphtheria
\nChronic : (i) Specific: Tuberculosis, syphilis, scleroma, fungal infections, (ii) Non-specific: Chronic laryngitis, atrophic laryngitis
\n\u25a1 Tumours
\nBenign : Papilloma (solitary and multiple), haemangioma, chondroma fibroma, leukoplakia Malignant: Carcinoma
\nTumour-like : Vocal nodule, vocal polyp, angiofibroma, masses amyloid tumour, contact ulcer, cysts, laryngocele
\n\u25a1 Trauma : Submucosal haemarrhage. laryngeal trauma (blunt and sharp), foreign bodies, intubation
\n\u25a1 Paralysis : Paralysis of recurrent, superior laryngeal or both nerves
\n\u25a1 Fixation of cords : Arthritis or fixation of cricoarytenoid joints
\n\u25a1 Congenital: Laryngeal web, cyst, laryngocele
\n\u25a1 Miscellaneous : Dysphonia plica ventricularis, myxoedema, gout
\n\u25a1 Functional : Hysterical aphonia<\/p>\n
DYSPHONIA PLICA VENTRICULARIS (VENTRICULAR DYSPHONIA)<\/p>\n
Here voice is produced by ventricular folds (false cords) which have taken over the function of true cords, voice is rough, low-pitched and unpleasant. Ventricular voice may be secondary to impaired function of the true cord such as paralysis, fixation, surgical excision, or tumours. Ventricular bands in these situations try to compensate or assume phonator function of true cords.<\/p>\n
Functional type of ventricular dysphonia occurs in normal larynx. Here cause is psychogenic. In this.type, voice begins normally but soon becomes rough when false cords usurp the function of true cords. Diagnosis is made on indirect laryngoscopy; the false cords are seen to approximate partially or completely and obscure the view of true cords on phonation. Ventricular dysphonia secondary to laryngeal disorders is difficult to treat but the functional type can be helped through voice therapy and psychological counselling.<\/p>\n
FUNCTIONAL APHONIA (HYSTERICAL APHONIA)<\/p>\n
It is a functional disorder mostly seen in emotionally labile females in the age group of 15-30. Aphonia is usually sudden and unaccompanied by other laryngeal symptoms. Patient communicates with whisper. On examination, vocal cords are seen in abducted position and fail to adduct on phonation; however adduction of vocal cords can be seen on coughing, indicating normal adductor function. Even though patient is aphonic, sound of cough is good. Treatment is given to reassure the patient of normal laryngeal function and psychotherapy.<\/p>\n
PUBERPHONIA
\n(MUTATIONAL FALSETTO VOICE)<\/p>\n
Normally, childhood voice has a higher pitch. When the larynx matures at puberty, vocal cords lengthen, and the voice changes to one of lower pitch. This is a feature exclusive to males. Failure of this change leads to persistence of childhood high-pitched voice and is called puberphonia. It is seen in boys who are emotionally immature, feel insecure and show excessive fixation to their mother.<\/p>\n
Psychologically, they shun to assume male responsibilities though their physical and sexual development is normal. Treatment is training the body to produce low-pitched voice. Pressing the thyroid prominence in a backward and downward diretion relaxes the overstretched cords and low tone voice can be produced (Gutzmann’s pressure test). The patient pressing on his larynx learns to produce low tone voice and then trains himself to produce syllables, words and numbers. Prognosis is good.<\/p>\n
PHONASTHENIA<\/p>\n
It is weakness of voice due to fatigue of phonatory muscles. Thyroarytenoid and interarytenoids or both may be affected. It is seen in abuse or misuse of voice or following laryngitis. Patient complains of easy fatiguability of voice. Indirect laryngoscopy shows three characteristic findings:<\/p>\n
\u25a1 Elliptical space between the cords in weakness of thyroarytenoid.
\n\u25a1 Triangular gap near the posterior commissure in weakness of interarytenoid.
\n\u25a1 Key-hole appearance of glottis when both thyroarytenoid and interarytenoids are involved.<\/p>\n
Treatment is voice rest and vocal hygiene, emphasising on periods of voice rest after excessive use of voice.<\/p>\n
HYPONASALITY (RHINOLALIA CLAUSA)<\/p>\n
It is lack of nasal resonance for words which are resonated in the nasal cavity, e.g. m, n, ng.
\nIt is due to blockage of the nose or nasopharynx.<\/p>\n
HYPERNASALITY (RHINOLALIA APERTA)<\/p>\n
It is seen when certain words which have little nasal resonance are resonated through nose. The defect is in failure of the nasopharynx to cut off from oropharynx or abnormal communication between the oral and nasal cavities.<\/p>\n
STUTTERING<\/p>\n
It is a disorder of fluency of speech and consists of hesitation to start, repetitions, prolongations or blocks in the flow of speech.<\/p>\n
When well-established, a stutterer may develop secondary mannerisms such as facial grimacing, eye blink and abnormal head movements. Normally, most of the children have dysfluency of speech between 2-4 years. If too much attention is given or child reprimanded by parents and peers, this behaviour pattern may become fixed and child may develop into an adult stutterer. Stuttering can be prevented by proper education of the parents, not to overreact to child’s dysfluency in early stages of speech development. Treatment of an established stutterer is speech therapy and psychotherapy to improve his image as a speaker and reduce his fear of dysfluency.<\/p>\n","protected":false},"excerpt":{"rendered":"
Hoarseness is defined as roughness of voice resulting from variations of periodicity and\/or intensity of consecutive sound waves.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[],"class_list":["post-5235","post","type-post","status-publish","format-standard","hentry","category-eye-care"],"yoast_head":"\n