CC Sept 2018 Hoarseness

echoecho's version from 2018-09-09 14:42


Question Answer
Define hoarseness?a SYMPTOM of altered voice quality
It is estimated that up to ______ of patients will suffer from hoarseness in their lifetime?one-third
The term dysphonia (often used interchangeably with hoarseness) is actually a DIAGNOSIS where an alteration in the production of voice impairs what?social and/or professional communication
In 3-2018, the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAOHNSF) issued a clinical practice guidelinee to improve the quality of care given to patients with hoarseness. Why does the guideline use the term "hoarseness" instead?because it is more widely recognized and used by both patients and clinicians
The guideline does not apply to what type of patients?those with a hx of 1) laryngectomy 2) craniofacial abnormalities 3) dysarthria (condition which problems occur w/ muscles that produce speech making it difficult to pronounce words)
Although hoarseness can occur at any age, in either gender, it is more commonly seen in those w/ professions involving intense voice usage, give an example of a profession?teachers
All ages are affected w/ older adults having a prevalence of ____%29
Hoarseness may be a symptom of a benign condition or a manifestation of more severe disease, list etiologic factors with %?acute laryngitis (42%); chronic laryngitis (10%); functional dysphonia (30%); neoplasms (benign)(11-31%); neoplasms (malignant)(2-3%); Neurogenic (vocal cord paralysis)(3-8%); aging (presbyphonia)(2%); psychogenic (2%)
How should providers diagnose hoarseness?1) dx based on clinical assessment that demonstrates altered voice quality, pitch or loudness 2) the resulting vocal effort impairs communication or reduces voice-related quality of life
Why should physicians take hoarseness seriously? because 1/2 of patients subsequently diagnosed with laryngeal cancer thought their hoarseness was benign
Hx should include voice-_____ questions as well as general questions that may help determine the etiology?specific
List the 5 categories that should be covered when asking pertinent medical history questions?1) voice specific 2) symptoms 3) medical history 4) acute conditions 5) chronic conditions
List the 4 questions to ask under the voice specific pertinent medical history questions?1) duration of symptoms 2) pain w/ speaking 3) deterioration of speaking w/ prolonged voice use 4) change in pitch or range; breaking or cracking
List the 4 questions to ask under symptoms pertinent medical history questions?1) dysphagia or odynophagia 2) cough, sore throat, postnasal drip, ear pain 3) hemoptysis, weight loss, night sweats 4) acid reflux, regurgitation, heartburn
List the 5 questions to ask under medical history pertinent medical history questions?1) occupation 2) prior episodes 3) relationship to instrumentation of head and neck surgery 4) prior episodes 5) anxiety
List the 3 questions to ask under acute conditions pertinent medical history questions?1) infections 2) trauma 3) foreign body
List the 5 questions to ask under the chronic conditions pertinent medical history questions?1) neurologic (stroke, Parkinson's disease, myasthenia gravis, multiple sclerosis, amyotrophic lateral sclerosis) 2) substance use (chronic tobacco use, moderate to heavy alcohol use) 3) endocrinopathies (diabetes, hypothyroidism) 4) cancer hx (larynx, lung, thyroid) 5) miscellaneous (chronic, chemical and allergic rhinitis, Sjogren's syndrome)
Also, identification of chronic medical conditions are important, why?because some pharmacologic therapy can CAUSE hoarseness
List the pharmacologic treatment that can cause hoarseness as to medical condition, medication and mechanism causing hoarseness? 1) osteoporosis = bisphosphonates (chemical laryngitis) 2) HTN = ACEI (cough), diuretics (mucosal drying) 3) allergy = antihistamines (mucosal drying) 4) psychiatric conditions = antipsychotics (laryngeal dystonia) 5) asthma, COPD = inhaled corticosteroids (mucosal irritation) 6) Parkinson's disease, overactive bladder, diarrhea = anticholinergics (mucosal drying)
When should referral to have a laryngoscopy be considered?1) if hoarseness is WORSENING 2) a serious condition is suspected 3) if hoarseness does not resolve after 4 weeks
Is there any recommendation for a swallowing study in workup of hoarseness?no
List the conditions that lead to a SUSPICION of a serious underlying cause of hoarseness?1) hoarseness associated with = hx of alcohol or tobacco use; concomitant discovery of neck mass: hemoptysis, dysphagia, odynophagia, otalgia or airway compromise; accompanying neurological symptoms; unexplained weight loss; possible aspiration of foreign body 2) hoarsenss in = immunocompromised host; neonate 3) hoarseness following = trauma, neck surgery or intubation
Are imaging studies (CT or MRI) routinely recommended in the evaluation of hoarseness?no
If what is found on direct laryngoscopy would recommend CT or MRI imaging?1) vocal cord paralysis 2) vocal cord malignancy
*** What therapy should be recommended for patients with hoarseness that has a significant effect on quality of life and has lasted > 2 weeks?VOICE therapy
Patients should not be referred for voice therapy until what has been done?1) direct visualization of the larynx with laryngoscopy has been done 2) results of the imaging should be communicated w/ the speech-language pathologist
If the patients w/ hoarseness does not improve within 4 weeks, have or are suspected to have laryngeal malignancy, benign laryngeal soft tissue lesions or glottis insufficiency, physicians should refer them to ENT for _______ therapy?surgical
In the cause of benign soft tissue lesions of the larynx, a trial of what should be done reasonably prior to surgery?1) non-surgery therapy (anti-reflux therapy for GERD patients) 20 tobacco cessation 3) voice therapy
The guidelines recommend AGAINST empiric use of H2 blockers or PPIs for patients w/ hoarseness but WITHOUT symptoms of GERD, why?because there is no evidence of efficacy
*** High quality controlled studies have shown a benefit of these GERD medications in patients w/ what symptoms?GERD; hoarseness
While EGD may be appropriate in GERD w/ hoarseness, should it be the initial study w/o documented GERD symptoms?no
Is there evidence for routine use of corticosteroids or antimicrobial therapy in the empiric treatment of patients w/ hoarseness?no
What injections may be considered for treatment of hoarseness due to spasmodic dysphonia?botulinum toxin injections
*** SUMMARY = Hoarseness is a common complaint that has a significant impact on quality of life and performance of daily activities, especially related to _____?work
*** SUMMARY = A variety of causes are reported, list these?infections, neoplastic, inflammatory disorders as well as voice overuse
*** SUMMARY = Current recommendations include a search for what?underlying cause with a thorough hx and physical exam, laryngoscopy and a recommendation of voice therapy