Dysphonia

Background

• Hoarseness or other abnormality of phonation
• Can indicate potential airway compromise

Causes/Differential Diagnosis

Emergent/urgent causes

• Tracheal injury, laryngeal airway trauma, Strangulation
• Posterior sternoclavicular dislocation
• Iatrogenic injury to recurrent laryngeal nerve: vagal nerve stimulator complication, ENT, thyroid, or thoracic surgery
• Foreign body aspiration
• Caustic ingestion, smoke inhalation injury, blister chemical agents
• Angioedema
• Hypothyroidism/myxedema of vocal cords
• Neck mass, squamous cell carcinoma, mediastinal adenopathy
• Aortic dissection, nontraumatic thoracic aortic dissection
• Epiglottitis, diphtheria
• Ludwig's angina
• Leishmaniasis
• Botulism
• Myasthenia gravis
• Acute flaccid myelitis
• Scorpion envenomation, Elapidae bites
• Stroke (lateral medullary infarction)
• Parkinson's disease

Non-emergent causes

• Laryngitis
• GERD
• Post intubation, laryngeal mask airway, or supraglottic airway
• Voice overuse/misuse
• Vocal cord nodules
• Voice may sound abnormal to you, but be totally normal for that patient!

Evaluation

• Evaluate airway!
• Testing/studies dependant on suspected underlying cause, based on history/exam

Management

• Secure airway!
• Further management based on underlying cause

See Also

• Laryngitis
• Stroke