Chapter 21: Hoarseness Assessment & Diagnosis

Hoarseness Assessment & Diagnosis details the anatomy of the larynx and the glottis while distinguishing between acute and chronic presentations, noting that symptoms persisting less than two weeks are typically due to self-limiting conditions like viral upper respiratory infections or acute vocal strain. In contrast, hoarseness lasting greater than three weeks necessitates a referral to an otolaryngologist to rule out malignancy, particularly squamous cell carcinoma, or structural lesions like polyps and cysts. The text emphasizes critical diagnostic reasoning, urging clinicians to assess risk factors such as tobacco and alcohol use, occupational exposure to dust or fumes, and a history of intubation or neck surgeries like thyroidectomy which may damage the vagus nerve. The chapter explores a wide range of differential diagnoses, including gastroesophageal reflux disease (GERD) which causes chronic irritation and morning hoarseness, and systemic conditions like hypothyroidism which presents with a gravelly voice and dry skin. Pediatric emergencies are highlighted, specifically epiglottitis, characterized by drooling and anxiety, and laryngotracheobronchitis (croup), distinguished by a barking cough and inspiratory stridor. The physical examination section outlines methods for acoustic voice evaluation, inspection of the oral mucosa and thyroid, and assessment of cranial nerves, while diagnostic studies such as indirect mirror laryngoscopy and flexible fiberoptic laryngoscopy are reviewed for visualizing laryngeal edema, nodules, or paralysis.