Hoarseness of voice is the commonest symptoms in otorhinolaryngological practice. The etiology
of hoarseness may varies from acute upper respiratory tract infections to
The aim of the study is to evaluate various causes,
predisposing factors and clinical profile of patients presenting with complaints
of hoarseness of voice. The duration of symptom varies from three weeks to 3 years.
A prospective study of cases of hoarseness of voice was
carried out in Department of ENT, Government Stanley medical college Chennai
from November 2016 to October 2017.
In the present
study of 100 cases 59 were males and 41 were females with M:F ratio of
1.43:1and age range from 11-90 years. Majority of the cases were in third and
fourth decade. Most common findings were chronic laryngitis and vocal nodule.
Most of the
etiopathological factors found in this study were treatable and significant patients
having neoplastic disease .So, early diagnosis with the help of
videolaryngoscopy and imaging can reduce
the morbidity and mortality.
of Voice, videolaryngoscopy, etiology, predisposing factors.
is the primary means of communications for humans. Voice is produced by a combination of laryngeal,
respiratory and resonance mechanisms and it was a primary means of
communication. Hoarseness is a vague term that is used to describe a change in
quality of voice ranging from harshness to weakness of voice.
of voice is defined as perceived rough, breathy or harsh quality voice. It is
the early and most common symptom of
pathology caused by simple
common cold to severe laryngeal malignancy. Voice disorders have a significant
influence on vocational, social and emotional adjustments of patients.
Hoarseness of voice lasts longer than two
weeks must be evaluated completely. Benign lesions are the most common causes
of hoarseness of voice than malignant pathologies. It is often the only early
signal of serious local or systemic disease(Von leden 1958).
Jackson stated that the hoarseness is important symptom of laryngeal diseases
and it is absent only when the cords and its motor mechanisms are free from
three phases of speech. The pulmonary phase create energy flow with expulsion
of air provides air column in larynx for the laryngeal phase in which vocal cord vibrates and produces
sound. The oral phase where sound is modified and words are formed by the
action of pharynx ,tongue, lips and
teeth. Dysfunction in any of these can cause change in voice .
hoarseness from a laryngeal origin usually results in rough raspy voice.
Hoarseness is merely a symptom not a diagnosis. Therefore it warrants a careful
investigation to find out the underlying pathology.
etiology of hoarseness of voice is varies and diverse. It can be divided into
acute and chronic onset. Acute onset may be secondary to viral infection, voice
abuse, smoking, trauma to larynx and post surgical. Chronic onset may be due to
vocal cord nodule, vocal cord polyp ,functional dysphonia, GERD ,post nasal
drip in chronic sinusitis, hypothyroidisms, laryngeal papilloma or neoplasms, malignant
neoplasms of thyroid esophagus, lungs, chronic granulomatous disease like
tuberculosis and neurological involvement.
study by simple random sampling of 100 cases of hoarseness of voice
attending ENT OPD of government Stanley medical college over a
period of 12 months from november2016 to october 2017. Age ,sex ,etiological
factors and videolaryngoscopic
examination findings are evaluated and analyzed .
The patient with complaints of change in voice
The duration of hoarseness of voice more than two weeks.
The age must be above 10 years and below 90 years
No history of previous head and neck surgeries and
AGE AND SEX DISTRIBUTION:-
Table 1:- age and sex
distribution of hoarseness of voice.
In our study among 100 cases 59
are males and 41 were females.Hoarseness
of voice was most commonly seen among males. And male to female ratio was
around 1.43:1 .Age range was between 15 years to 82 years.A majority of
patients were presented in third
decade(23%) and fourth decade(22%) followed by fifth decade(14%).Females were
presented at slightly younger age than male.
Total Number of cases
Chart 1. Age and sex
distribution of hoarseness of voice
DIAGNOSIS BY VIDEOLARYNGOSCOPY
common cause was chronic laryngitis(32%)
followed by vocal nodule(26%), vocal cord palsy(17%), vocal cord polyp. There
was male predominance in laryngitis. Vocal nodules were most common among female
Table 2:-Diagnosis ,sex
distribution and incidence of hoarseness of voice.
Chart 2:- Diagnosis and its incidence among male and female.
Pic 1:-Vocal cord cyst Pic 2:-VC haematoma
Pic 3:-vocal cord palsy Pic4 :- Haemorrhagic polyp
Pic 5:-Tuberculosis Pic 6:-vocal nodule
Pic7 :-Glottic malignancy
DURATION AND PRESENTING COMPLAINTS:-
of hoarseness ranges from 3 weeks to
Complaints of voice change
was the predominant symptom present in all the patients followed by
cough,fever, foreign body sensation in throat,voice fatigue ,heart
burns,dyspnoea,weight loss,post surgical or trauma and dysphagia.
complaints with hoarseness of voice:-
including vendors (45%)formed the predominant group followed by
housewives(25%), students(9%), teachers and singers (10%) and others(11%).
Chart 4:-Professional distributions.
The most predominant predisposing factor
associated with hoarseness of voice was smoking(34%) followed by alcohol(29%), tobacco usage(13%), voice abuse(14%),
laryngopharyngeal reflux (17%),respiratory tract infection(30%) and septic
GEOGRAPHIC DISTRIBUTION :-
Most of the patients are from urban
areas in Chennai surrounding Stanley medical college about 72% .28% patients
are from rural areas covered by Government Stanley medical college hospital.
study 100 patients with hoarseness of voice were discussed in detail. The
majority of the cases are in the age group of 31-40 years which correlates with the study by Vengala et
al and Pal KS et al study.
Among them 59 were male and 49 were female.Males were
affected more than females in the ratio of 1.43:1 this study. Similar results
were obtained in Ghosh KS et al study.
disorders are classified into two types.
Among the organic
voice disorders the most common chronic laryngitis(32%).In chronic laryngitis
male predominance was seen with male and female ratio 1.66:1. Among them the
major predisposing factors were smoking and laryngopharyngeal reflex.
most common finding in the study was vocal nodule (26%) with male and female
ratio of 1:1.6. It was the most common pathology found among females most of
them were housewives and street vendors.
Similar results were obtained In Parik et al and Ghosh et al studies.
palsy was the next common etiology in this study(17%) with male predominance.
Male predominance was there.mostly unilateral cord palsy. Left vocal palsy was
more observed than right cord palsy.
of other etiologies in descending orders were neoplasm(7%),vocal cord polyp
(5%),functional (5%),vocal cord cyst
(2%),tuberculosis(2%),trauma(2%),subluxation (1%)and foreign body(1%).
7% were found to have
malignant pathologies hence hoarseness of voice should not be deal with ease.
Early diagnosis and proper treatment must be warrented.
professions were discussed in this study.
and isaacson’s classification of vocal professionals.It was based on their
voice use and risk.
1.Group I:- elite vocal performers.
Singers and actors-wher even a
slight voice difficulty Causes serious consequences
2.Group lI:-professional voice users
,politicians,public speakers-moderate difficulty hampers their job performance.
III:-non vocal professionals
and lawyers-only severe dysphonia endangers the job.
IV:-non vocal noprofessionals
,homemakers and clerks
study most of the patients were labourers including vendors(45%) followed by
housewives(25% ) . Smoking habit was more among
and singers (10%) was the next common group affected with voice change due to
predisposing factors smoking is predominant in smoking (34%) which correlates
with Baitha S and Pal KS et al studies.
The other predisposing factors in descending order were URTI(30%),
alcohol(29%), laryngopharyngeal reflux(17%), voice abuse (14%), tobacco
usage(13%)and septic foci (7%).Smoking
and tobacco usage plays a major role in laryngitis and malignancy.
study hoarseness of voice was associated with heart burns(27%), recurrent
URI(23%), vocal fatigue (20%),breathy voice(17%) which correlates with Hansa et
al studies .
Most of the
patients were from urban area(72%)and rural area(28%).
More common among the urban
population due to increased addiction to smoking and alcohol at earlier age
than rural population.
OF HOARSENESS OF VOICE:-
present study most of the patients were referred to speech therapy. The lesions
of infectious origin such as chronic
laryngitis ,laryngopharyngeal reflux, tuberculosis , chronic sinusitis were
advised medical therapy along with speech therapy.
malignant lesions were proceeded with microlaryngeal examination and excision
biopsy for histopathological examination. The patients with vocal cord paresis
and paralysis were advised for complete cardiological, chest medicine and
neurological evaluation to diagnose the underlying pathology.
Vocal cord polyp and cyst lesions should also be
treated with voice therapy initially must proceeded with microlaryngeal
surgical excision to rule out malignancy.
Treatment of voice patients
requires many disciplines. Treatment by an interdisciplinary team is important
which is formed by laryngologist, speech-language pathologists, voice therapist
The etiology of hoarseness of voice varies from
trivial infections to life threatening malignancies.A proper history, physical
examination and detailed investigations can lead to appropriate diagnosis
of voice mostly due to chronic laryngitis(33%) followed by vocal nodules(26%)
and vocal cord palsy(17%). Commonly occurs in third decade of life. Male were commonly affected than female.
Majority of them were labourers. Smoking , alcohol, tobacco and laryngopharyngeal reflux were the common
The treatment varies from from speech therapy to
surgical intervention. Although most of them were treatable malignancy also
present with the similar complaints. 7%
of the cases were diagnosed as malignancy.Hence early diagnosis with videolaryngoscopy ,biopsy
and imaging reduces mortality and morbidity.