Hoarseness

CLINICAL DIAGNOSTIC MANUAL

Hoarseness refers to an abnormal change in the voice, characterised by a raspy, weak, or strained vocal quality. This symptom can result from various conditions affecting the vocal cords and larynx, including inflammation, lesions, and neuromuscular disorders.

Hoarseness can be acute or chronic, and persistence for more than two weeks may indicate a more serious underlying pathology. A thorough evaluation is essential to identify the cause and determine appropriate treatment.

Pathology	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Inhaled steroids	Hoarseness, throat irritation, dry cough	Clinical history, use of inhaled steroids	Discontinuation of medication, clinical evaluation
Chronic laryngitis	Persistent hoarseness, dry cough, sore throat, sensation of a foreign body	Clinical history, physical examination, laryngoscopy	Laryngoscopy, biopsy if necessary
Singer’s nodules	Hoarseness, vocal fatigue, change in voice pitch	Clinical history, excessive voice use	Laryngoscopy, videostroboscopy
Laryngeal carcinoma	Persistent hoarseness, sore throat, dysphagia, weight loss, neck mass	Clinical history, physical examination, chest X-ray	Laryngeal biopsy, computed tomography (CT), laryngoscopy
Vocal cord paralysis	Hoarseness, dyspnoea, difficulty speaking, ineffective cough	Clinical history, physical examination, laryngoscopy	Laryngoscopy, electromyography of vocal cords
Functional hoarseness	Hoarseness without apparent organic lesion, voice fluctuations	Clinical history, physical examination	Evaluation by a speech therapist or phoniatrician
Myxedema	Hoarseness, fatigue, dry skin, cold intolerance, weight gain	Clinical history, physical examination, thyroid function tests	Thyroid function tests (TSH, free T4)
Acromegaly	Hoarseness, deep voice, thickening of vocal cords, coarse facial features	Clinical history, physical examination, hormonal tests	Hormonal tests (IGF-1, GH), magnetic resonance imaging (MRI)
Sicca syndrome	Hoarseness, dry eyes and mouth, difficulty swallowing	Clinical history, physical examination, serological tests	Serological tests (SSA/SSB antibodies), salivary gland biopsy
Granulomas	Hoarseness, sore throat, persistent cough, dysphonia	Clinical history, physical examination, laryngoscopy	Laryngoscopy, granuloma biopsy