ABSTRACT:-

INTRODUCTION:-

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Hoarseness of voice is the commonest symptoms  in otorhinolaryngological practice. The etiology
of hoarseness may varies from acute upper respiratory tract infections to
laryngeal malignancy.

AIM:-

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.

METHOD:-

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.

RESULTS:-

                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.

CONCLUSIONS:-

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.

KEYWORDS:- Hoarseness
of Voice, videolaryngoscopy, etiology, predisposing factors.

INTRODUCTION:-

                Voice
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.

Hoarseness
of voice is defined as perceived rough, breathy or harsh quality voice. It is
the early and most common  symptom of
laryngeal

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 and
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
diseases.

There are
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 .

True
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.

The
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.

METHODS AND
MATERIALS :-

A prospective
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 .

Inclusion
criteria:-

1.      
The patient with complaints of change in voice

2.      
The duration of hoarseness of voice more than two weeks.

3.      
The age must be above 10 years and below 90 years

4.      
No history of previous head and neck surgeries and
radiation.

 

OBSERVATION
AND RESULTS:-

 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.

 

S.No

Age group

Male

Female

Total Number of cases

1.
 
2.
 
3.
 
4.
 
5.
 
6.
 
7.
 
8.

11-20 years
21-30 years
31-40 years
41-50 years
51-60 years
61-70 years
71-80 years
81-90 years
 

4
 
11
 
9
 
13
 
10
 
9
 
2
 
1

3
 
7
 
14
 
9
 
4
 
4
 
0
 
0

7
 
18
 
23
 
22
 
14
 
13
 
2
 
1

Chart 1. Age and sex
distribution of hoarseness of voice

 

 

DIAGNOSIS BY VIDEOLARYNGOSCOPY
FINDINGS:-

The most
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
patients.

 

Table 2:-Diagnosis ,sex
distribution and incidence of hoarseness of voice.

S.No

Diagnosis

Male

Female

Incidence

1.
2.
3.
 
4.
 
5.
 
6.
 
7.
8.
9.
10.
11.

Laryngitis
Vocal
nodule
Vocal cord
palsy
Vocal cord
polyp
Vocal
cord cyst
Foreign
body
Tuberculosis
Subluxation
Neoplasm
Trauma
Functional

20
10
12
 
3
 
2
 
1
 
1
0
7
1
3

12
16
5
 
2
 
0
 
1
 
1
1
0
1
2

32
26
17
 
5
 
2
 
1
 
2
1
7
2
5

 

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:-

The duration
of hoarseness ranges from 3 weeks  to
three years.

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.

 

 

Table 3:-Presenting
complaints with hoarseness of voice:-

S.No

Presenting
complaints

Percentage
of occurrence

1.

Hoarseness
of voice

97

2.

Vocal
fatigue

20

3.

Breathy
voice

17

4.

Cough

15

5.

Foreign
body sensation

6

6.

Recurrent
URTI

23

7.

Swelling
in neck

5

8.

Heart
burns

27

9.

Weight
loss

9

10.

Fever

5

 

 

Chart 3:-Presenting
complaints.

 

OCCUPATION:-

                Labourers
including vendors (45%)formed the predominant group followed by
housewives(25%), students(9%), teachers and singers (10%) and others(11%).

 

Chart 4:-Professional distributions.

 

PREDISPOSING FACTORS:-

 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
foci(7%).  .

 

 

Chart 5:-Predisposing
factors.

 

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.

Chart 6:-Geographic
distributions

 

 

 

 

DISCUSSION:-

In this
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.

Voice
disorders are classified into two types.

1.Functional
voice disorders

2.Organic
voice disorders

                 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.

The second
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.

Vocal cord
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.

Incidence
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.

Various
professions were discussed in this study.

Koufmann
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

Lectures ,
,politicians,public speakers-moderate difficulty hampers their job performance.

3.Group
III:-non vocal professionals

Teachers
and lawyers-only severe dysphonia endangers the job.

4.Group
IV:-non vocal noprofessionals

Labourers
,homemakers and clerks

In our
study most of the patients were labourers including vendors(45%) followed by
housewives(25% ) . Smoking habit was more among 
the labourers.

Teachers
and singers (10%) was the next common group affected with voice change due to
voice abuse.

Among the
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.

In our
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.

 

MANAGEMENT
OF HOARSENESS OF VOICE:-

                In
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.

Suspicious
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
and psychologist.

 

CONCLUSIONS:-

                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

                Hoarseness
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
predisposing factors..

                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.

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