Voice Change
Overview
Dysphonia refers to hoarseness of the voice, which may be acute or chronic. The differential diagnosis for this symptom includes pathology affecting the vocal cords, muscles powering phonation or nerves supplying the vocal cords.
Aetiology
Causes of Hoarseness (Dysphonia)
Vocal Cords
- Irritation - alcohol, tobacco, reflux, pollutants, inhaled chemicals
- Laryngitis - viral, bacterial, fungal
- Vocal cord trauma - direct trauma, chronic cough, vocal abuse
- Vocal cord mass - nodules, polyps, cyst, tumour
- Medications - ACE inhibitors, antihistamines, inhaled steroids
Neurological / Neuromuscular / Muscular
- Peripheral - vagus / recurrent laryngeal nerve palsy
- CNS - meningitis, tumour, small vessel ischaemia, MS, Parkinson's
- Myasthenia gravis
- Spasmodic dysphonia
Other
- Psychogenic
History of Presenting Complaint
Timing
When the hoarseness started, and how long it has been going on for.- Onset post shouting, screaming or singingSuggestive of vocal cord trauma / muscle fatigue
Associated Symptoms
Whether the voice change is associated with any other symptoms.- FeversSuggestive of infection e.g. laryngitis
- Coryzal symptomsSuggestive of laryngitis
- HeartburnSuggestive of reflux-associated vocal cord irritation
- Dysphagia or odynophagiaSuggestive of acute laryngitis or laryngeal mass
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