Hoarseness, also known as hoarseness, is a major symptom of laryngeal (especially vocal cord) lesions, mostly caused by laryngeal lesions, but can also be caused by systemic diseases. The degree of hoarseness varies depending on the severity of the lesion, from low pitch and coarsening in mild cases to hoarseness and even whispering or loss of voice in severe cases.
Causes of hoarseness
Acute laryngitis
Acute laryngitis is the most common, and hoarseness is the main symptom. Acute laryngitis in children is more severe than that in adults, with symptoms such as fever and cough in addition to hoarseness. On laryngoscopy, acute congestion of the laryngeal mucosa, edema of the vocal folds with purulent secretions, and varying degrees of restriction of vocal fold movement are seen. The disease should be differentiated from laryngeal diphtheria and respiratory foreign bodies.
Pharyngeal diphtheria
Most often secondary to pharyngeal diphtheria. Hoarseness and dry cough are the first symptoms of laryngeal diphtheria, mostly seen in children. At the beginning of the disease, the articulation is rough and gradually worsens from hoarseness to complete loss of voice. In addition to laryngeal symptoms, the patient has obvious toxicity. On laryngoscopy, the mucosa is red and swollen with a white pseudomembrane covering the surface. Smear and culture can confirm the diagnosis.
Chronic laryngitis
Patients with chronic laryngitis often complain of dryness and discomfort in the throat, frequent coughing in the morning, and mucous secretions. Vocal tone is low, coarse to sandy, hoarse, and varies with the severity of inflammation. There are 3 different types of laryngoscopy.
1, simple type The laryngeal tympanic membrane is diffusely congested, smooth and moist, with small venous dilatation and poor vocal fold closure during vocalization.
2, hypertrophic type The laryngeal mucosa is congested and symmetrically hypertrophic, with limited focal polyp-like or papillary protrusions.
3.Atrophic type Mucosa is dry, atrophied and crusted.
Hypertrophic laryngitis should be differentiated from tumors, and biopsy can clarify the diagnosis.
Laryngeal nodules
Primary ones are rare, mostly secondary to open tuberculosis. In the early stage, the patient feels dryness and discomfort or slight pain in the larynx, and the voice is easily fatigued or mildly hoarse. Examination shows that the laryngeal mucosa is pale, and one side of the vocal cord is also congested. In the late stage, the hoarseness is significant and the laryngeal mucosa is ulcerated, often on one side of the vocal folds or in the interarytenoid region. The diagnosis can be confirmed by X-ray chest fluoroscopy, chest X-ray and biopsy.
Vocal fold nodules
It is a type of chronic laryngitis, also known as nodular vocal fold inflammation. It is most commonly seen in soprano actors, elementary school teachers, and workers in noisy environments. It occurs mainly in the anterior and middle 3 migrations of the vocal folds. The nodules are soft in the early stages and become hard in the later stages. The nodules are mostly symmetrical and equal in size, but there are cases where one side is larger and the other side is smaller, or even only one side. The nodules show only a small limited elevation, but not excessive enlargement. The pathology is characterized by limited thickening and keratinization of the vocal fold epithelium.
Vocal fold polyps
Most often occur after excessive or inappropriate vocalization or after an intense vocalization, with local injury being the main factor. Early vocal fold polyps are confined to the Reinke layer above or below the anterior and middle 3 vocal folds on one side and show edematous degeneration. Later stages may present small mucus cysts, glassy degeneration or fibrous hyperplasia. The polyp bases are mostly tipped, but there are also extensive bases. Vocal fold polyps usually only cause hoarseness, and their degree is related to the location and size of the polyps.
Vocal fold papilloma
The cause is unknown and is thought to be related to a viral infection or to sex hormones. In children, papillomas have a tendency to be multiple, with a tendency for the tumor to become self-limiting with age. In adults, papillomas are prone to carcinogenesis. Papillomas can occur anywhere in the laryngeal mucosa, with the anterior segment of the vocal cord being the most common. The tumor is cauliflower-like or cockscomb-like.
Laryngeal cancer
Squamous cell carcinoma is the most common malignant tumor of the larynx. According to the site of occurrence, it is clinically divided into 3 types: supraglottis, glottis and infraglottis. The vocal fold type is often located in the middle or anterior part of the vocal folds, so there are hoarse symptoms very early. On laryngoscopic examination, one side of the vocal folds is seen to be congested, with rough and uneven surface, granular elevation or papillary hyperplasia, which can be confirmed by biopsy, making the diagnosis relatively easy. The supraglottic and infraglottic types, whose early symptoms are often not hoarseness, are more difficult to diagnose.
Paralytic
1. Supraglottic nerve palsy
Since the superior laryngeal nerve is responsible for the sensation of the laryngeal membrane and innervates the movement of the cricothyroid muscle. Therefore, when the superior laryngeal nerve is paralyzed on one side, the vocal folds lack tension, and the voice is weak and easily fatigued when vocalizing, and the sound quality is rough. When examined, the vocal folds on the affected side are corrugated and flutter up and down with the respiratory flow.
2.Unilateral paralysis of the recurrent laryngeal nerve is hoarse and easily fatigued, often presenting a ruptured voice, and there is a sense of air leakage when speaking and coughing; later, compensation appears, and the healthy side appears to be inward over the midline against the affected side, and the vocalization improves.
3.Bilateral laryngeal recurrent nerve palsy
Sudden onset of bilateral vocal fold abduction paralysis can cause acute laryngeal obstruction. If the onset is gradual, the patient may adapt without respiratory distress, and the effect on vocalization is not significant. If both adduction and abduction are paralyzed, vocalization is hoarse and weak, and speech is difficult and unsustainable. The vocal cords are bilaterally positioned in the middle, flaccid, and the edges are still regular. Aspiration may occur easily, and coughing and sputum discharge may be difficult.
4.Aryepiglottis muscle paralysis
It is mostly myopathic paralysis, which is caused by excessive fatigue of the arytenoid muscle. Atrophy of nerve endings in the late stage of laryngeal muscle weakness can also be included in this. Pronunciation is low and coarse and easily fatigued. The inward and outward movements of the vocal folds are normal. The vocal folds close normally during vocalization, but there is a prismatic cleft between the membranes.
5.Intertriginous muscle paralysis Intertriginous muscle damage alone is rare, often caused by nerve damage on both sides. It is seen after acute or chronic inflammation of the larynx or delusional use of noise. When pronouncing, there is a triangular cleft at the posterior end of the vocal folds after both sides are closed.
6.Unilateral posterior cricoarytenoid muscle paralysis
Also known as unilateral median vocal fold paralysis, it is the most common type of vocal fold paralysis. It is mainly caused by damage to the posterior branch of the terminal branch of the recurrent laryngeal nerve. The symptoms are not obvious and start with temporary hoarseness, which disappears after compensation. The vocal cords on the affected side are fixed in a median position. Subsequently, the paralyzed muscles lose muscle tone, resulting in augmentation of the arytenoid cartilage. Due to the loss of support of the aryepiglottic folds, the arytenoid cartilage on the affected side is displaced anteriorly.
Common population.
And due to the nature of work, excessive use of the voice, improper vocalization caused by vocal cord polyps, vocal cord nodules caused by hoarseness is the most common modern occupational disease of professional managers, business representatives, teachers, musicians, etc.
People who are in a polluted environment such as dust for a long time.