hoarseness of voice

If hoarseness continues for more than 3 weeks, the patient requires urgent examination to rule out laryngeal cancer. Hoarseness occurs when the normally very smooth vocal cords do not close together for one reason or another. The causes of hoarseness can be different - neurological, muscular (in this case, paralysis of the vocal cords occurs), but the vocal cords themselves may also be to blame. Laryngeal problems usually occur in adult patients due to hoarseness, but this can also be the cause of breathing problems.

Examination of the patient. First of all, it is necessary to perform a laryngoscopy in order to observe the mobility of the vocal cords, assess the condition of the mucous membrane and exclude local causes.

Causes of hoarseness:

• Acute: laryngitis, angioedema, laryngeal abscess, trauma (sharp scream, cough, vomiting, inhalation of harmful substances);
• Chronic (in this case, hoarseness lasts more than three weeks): laryngitis, granulomatous lesions of the larynx (syphilis, tuberculosis, sarcoidosis, Wegener's granulomatosis); paralysis of the vocal cords; laryngeal cancer; endocrine disorders (acromegaly, Addison's disease, myxedema); functional disorders; dry syndrome (in this case, poor lubrication of the vocal cords is noted).

Laryngitis. Most often, this is a viral, self-limiting disease. However, it may also be caused by a secondary streptococcal or staphylococcal infection. In addition to hoarseness, patients with laryngitis usually complain of feeling unwell, fatigue, and fever. There may also be pain in the lower pharynx, dysphagia, and pain during phonation. Edema is visible during direct laryngoscopy. If necessary, it is advisable to prescribe penicillin-V 500 mg every 6 hours for a week.

Laryngeal abscess (abscess of the larynx). This is a rare condition that occurs secondary to trauma (eg, after endotracheal intubation). It is characterized by sharp pain, fever, pain when swallowing (dysphagia), and sometimes respiratory distress. The cervical lymph nodes may enlarge. An attempt to slightly move the larynx laterally causes sharp pain. A lateral neck X-ray may show a "level" (the boundary between fluid and air) and deformation of the larynx. Fiberoptic laryngoscopy is used to assess the size of the laryngeal inlet and determine the need for a tracheostomy. The disease is usually caused by Pseudomonas, Proteus, and staphylococcus, so treatment should be aimed at suppressing their growth. Netilmicin is prescribed at a rate of 2-3 mg/kg every 12 hours intravenously (while it is necessary to monitor the concentration of the drug in the blood) and flucloxacillin at 500 mg every 6 hours intravenously. If there is no improvement after 24 hours, surgical drainage should be considered.

Singer's nodes. They are a consequence of speech (vocal) overload. These are small fibrous nodules that occur at the junction of the anterior and posterior 2/3 of the vocal cords. The nodules can be removed.

Functional disorders. This is a functional hysterical paralysis of the adductor muscles of both vocal cords during phonation. This condition usually occurs in young women during emotional stress. The voice may disappear completely (aphonia occurs). More often, such a patient begins to speak in a whisper. However, the vocal cords still close when coughing, so patients are usually unable to speak, but can cough. In such cases, it is most appropriate to talk to the patient and calm him down.

Paralysis of the laryngeal nerve. In this case, Semyon's law applies: in case of damage to the recurrent laryngeal nerve, the abductors are paralyzed first, and then the adductors.

Causes: 30% of cases of paralysis are idiopathic, 10% are of central origin (e.g., due to poliomyelitis, syringomyelia); thyroid cancer; trauma (thyroidectomy); cancerous cervical lymph nodes, cancer of the esophagus, hypopharynx or bronchus; tuberculosis; aortic aneurysm; neuritis. In partial paralysis of the recurrent laryngeal nerve, the vocal cords are fixed in the midline; in complete paralysis, they are fixed "halfway".

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