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Head and NeckSigns and Symptoms

Hoarseness: Causes of Hoarseness: Examination and Investigations

Hoarseness, causes, management and investigations HOARSENESS

Hoarseness is defined as roughness of voice, which results from an abnormality within the larynx with variation in periodicity, and intensity of consecutive sound waves.

Patho-physiology Of Hoarseness:

For the normal production of voice vocal cords should be able to approximate properly with each other, have a proper size and stiffness and have an ability to vibrate in response to air column. Any condition that interferes with these functions may cause hoarseness. Loss of approximation may be seen in vocal cord paralysis, fixation of crico-arytenoid joint or any lesion present between the cords, preventing its approximation. Size and stiffness of the vocal cords may change due to paralysis, edema, tumor, fibrosis and partial surgical excision. Cords are unable to vibrate properly in the presence of edema, congestion, sub-mucosal hemorrhage, nodule, polyp or tumor.

Causes of Hoarseness:

Hoarseness may be acute (less than few weeks in duration) or chronic (more than few weeks in duration) in type.

The causes of acute hoarseness are:

  • Acute inflammation Acute laryngitis
  • Acute laryngo-tracheo-bronchitis
  • Laryngeal diphtheria
  • Trauma
    • a- Vocal abuse
    • Foreign body in the larynx
    • Inhalation of irritant fumes
    • Cut throat
    • Intubation & other instrumentation
    • External injury to larynx
  • Sudden paralysis of vocal cords
    • After thyroidectomy
    • Trauma to recurrent laryngeal nerve
    • Other neurological conditions like CVA
  • Laryngeal edema due to allergy
  • Functional e.g. psychosomatic, hysteria


The causes of chronic hoarseness are:

  • Congenital
  • Laryngeal web
  • Congenital laryngeal paralysis
  • Congenital cysts and tumors
  • Chronic Inflammation e.g., Chronic laryngitis
  • Laryngeal tuberculosis c- Other chronic inflammations e.g. Syphilis
  • Intubation granuloma
  • Vocal nodules
  • Tumors of larynx: benign and malignant
  • Vocal cord paralysis
  • Vocal cord polyp
  • Laryngocoele


Sometimes weakness of voice is present which is not true hoarseness, as in:

  • Myasthenia gravis
  • General debility
  • Myxoedema
  • Functional dysphonia
  • Acromegaly
  • Covalescence from severe illness


Management Of Patient with Hoarseness

History: Mode of onset and duration of Hoarseness is very important. Any hoarseness persisting for more than three weeks requires thorough examination and investigations and the malignancy should be excluded first, especially in patients above forty years of age. Patient’s occupation, habits and associated complaints should be noted to find the cause.

Examination: Examination of the larynx by indirect laryngoscopy or flexible laryngoscopy is very helpful. Examination of the neck, oral cavity, nose and chest must be done thoroughly.

Investigations: Laboratory and radiological investigations should be done accordingly. Direct laryngoscopy examination and biopsy of any lesion may be needed.

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