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, 112 (19), 329-37

Hoarseness-causes and Treatments


Hoarseness-causes and Treatments

Rudolf Reiter et al. Dtsch Arztebl Int.


Background: Hoarseness (dysphonia) is the reason for about 1% of all consultations in primary care. It has many causes, ranging from self-limited laryngitis to malignant tumors of the vocal cords.

Methods: This review is based on literature retrieved by a selective search in PubMed employing the terms "hoarseness," "hoarse voice," and "dysphonia," on the relevant guideline of the American Academy of Otolaryngology -Head and Neck Surgery, and on Cochrane reviews.

Results: Hoarseness can be caused by acute (42.1%) and chronic laryngitis (9.7%), functional vocal disturbances (30%), and benign (10.7-31%) and malignant tumors (2.2-3%), as well as by neurogenic disturbances such as vocal cord paresis (2.8-8%), physiologic aging of the voice (2%), and psychogenic factors (2-2.2 %). Hoarseness is very rarely a manifestation of internal medical illness. The treatment of hoarseness has been studied in only a few randomized controlled trials, all of which were on a small scale. Voice therapy is often successful in the treatment of functional and organic vocal disturbances (level 1a evidence). Surgery on the vocal cords is indicated to treat tumors and inadequate vocal cord closure. The only entity causing hoarseness that can be treated pharmacologically is chronic laryngitis associated with gastro-esophageal reflux, which responds to treatment of the reflux disorder. The empirical treatment of hoarseness with antibiotics or corticosteroids is not recommended.

Conclusion: Voice therapy, vocal cord surgery, and drug therapy for appropriate groups of patients with hoarseness are well documented as effective by the available evidence. In patients with risk factors, especially smokers, hoarseness should be immediately evaluated by laryngos - copy.


Figure 1a
Figure 1a
Indirect laryngoscopy during phonation
Figure 1b
Figure 1b
Indirect laryngoscopy during respiration
Figure 2
Figure 2
Algorithm for diagnosis of hoarseness. ENT, ear, nose, and throat; VCD, vocal cord dysfunction; PPI, proton pump inhibitor; EGD, esophagogastroduodenoscopy; VC, vocal cord
Figure 3
Figure 3
Laryngoscopy in a heavy smoker with chronic leukoplakia and bilateral sulcus vocalis. His voice sounded husky and strained

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