ENT: Clinical Approach to Hoarseness
High-Yield Diagnostic Framework for Board Review & PG Entrance Examinations
Hoarseness (Dysphonia) is a change in the quality of the voice. Any patient presenting with hoarseness lasting > 3 weeks mandates a thorough laryngeal examination to rule out malignancy.
1. Categorizing Etiologies
| Category | Key Examples |
|---|---|
| Inflammatory | Acute laryngitis (viral), LPR/GERD, Reinke’s edema. |
| Structural | Vocal nodules, polyps, cysts, and laryngeal papilloma (HPV). |
| Neurological | Vocal cord paralysis (RLN involvement), Parkinson’s disease. |
| Neoplastic | Laryngeal SCC, glottic/supraglottic carcinoma. |
2. Critical Red Flags (Must Rule Out Cancer)
- Duration: Chronic hoarseness (>3 weeks) in a smoker.
- Associated Symptoms: Dysphagia, odynophagia, weight loss, hemoptysis, or a neck mass.
- Voice Features: Rapidly deteriorating voice or worsening stridors.
3. High-Yield Board Exam Facts
- Diagnostic Gold Standard: Indirect laryngoscopy (mirror) or flexible/rigid fiberoptic laryngoscopy for definitive visualization.
- LPR/GERD: Often causes posterior laryngeal inflammation (pachydermia) and “interarytenoid bar” formation.
- Reinke’s Edema: Specifically associated with heavy smoking; presents with low-pitched, “smoker’s voice” and gelatinous swelling of the vocal cords.
- Papilloma (RRP): Caused by HPV types 6 and 11; prone to recurrence post-excision.