Red Flags:
External Laryngeal Trauma
Neoplastic etiologies

Clinical Pearls:

  1. Listen to the voice! The worse the voice, the more investigation is warranted.
  2. Explore the impact on the patient’s job, daily living, etc.
  3. Look out for heavy smokers with gradually worsening voice.
  4. If hoarseness is associated with otalgia, odynophagia, dysphagia, rule out the etiologies with poor prognoses.
  5. Always ask about vocal abuse or overuse.
  6. If fairly sudden onset of a breathy voice – think paralysis.

Nodules Polyps Granuloma CystsReinke's Edema Malignancy: Squamous Cell CarcinomaBenign: Papilloma (HPV 6 & 11) Dysplasia: Leukoplakia Acute < 3 weeks Hoarseness If Hoarseness persists > 3 months, Refer to ENT Non-Acute > 3 weeks Constant Variable Infectious Inflammatory Neoplastic Benign Mucosal Changes Trauma Neurological Bacterial Infection Fungal Infection (Monilia) Chronic Laryngitis GERD Smoking ExternalInternal (Surgery, Intubation) Vocal Cord Paralysis Spasmodic Dysphonia Tremor HOARSENESS: Non-Acute Functional

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