Aetiopathological study of hoarseness of voice

Chitra, S (2013) Aetiopathological study of hoarseness of voice. Masters thesis, Tirunelveli Medical College, Tirunelveli.


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INTRODUCTION: Voice is the primary means of communication for human both socially and in the work place1. Human voice serves number of communicative functions, some associated with this spoken language and others unrelated to speech and language voice alone, can communicate several nonverbal messages. Clear pleasing confident voice convey positive impression of adequate personality while weak self effacing voice that necessitates the listener straining to hear reflect shy – withdrawn personality. Voice disorders are rarely life threatening, but cause tremendous alteration in day today living and should not be underestimated as a medical disorder. First persons to be approached when voice sounds abnormal is usually otolaryngologists. Hoarseness is a symptom, not a diagnosis. It is a common symptom encountered by primary care providers. Hoarseness has a lifetime prevalence of 30%. At any point in time, 3% to 9% of general population is affected by some type of voice abnormality the negative effect of voice disturbance on quality of life and economic productivity is significant and has been well documented. Hoarseness is the term used to described a change in normal voice. Quality and it is invariability the earliest manifestation of a large variety of conditions directly and indirectly affecting the voice apparatus. AIMS & OBJECTIVES: 1. Analyse clinical profile of hoarseness 2. To find out common etiology of hoarseness of voice 3. To find out association of common Predisposing factors leading to hoarseness. 4. To study management of hoarseness of voice. MATERIALS AND METHODS: The voice is the primary means of communication for humans. Although rarely life threatening, voice problems cause tremendous alterations in daily living and should not be underestimated. A complaint of hoarseness may represent serious disease and therefore should not be ignored, especially if present for more than 2 weeks. It needs a complete evaluation to rule out malignancy as a cause. Study setting: This Prospective study was carried out in Department of ENT, Tirunelveli Medical College hospital, Tirunelveli. Study Duration: This study was carried during July 2011 to August 2012. Study Design: Prospective study was conducted during 1 year study period. Study Population: Patients attending ENT department of Tirunelveli Medical College Hospital, Tirunelveli and also patients referred from other department in the same hospital. A total of 60 cases were studied during the study period. Inclusion criteria: Patients presenting with hoarseness of voice of ≥ 2 weeks duration. Exclusion Criteria: 1. Patients with hoarseness of voice < 2 weeks of duration. 2. Voice disorders other than hoarseness like rhinolalia aperta, rhinolalia clausa etc. CONCLUSION: Production of voice is complex mechanism. The vocal folds produce tone that becomes modified by pharynx, palate, tongue, nose and lips to generate the individual sounds of speech. Not much work has been carried out in this field, Parik12 (1991) mentions, and “It is however strange that hoarseness as a subject has not attracted the attention of many workers” In our present study incidence of hoarseness voice was 0.27% of total ENT cases. Maximum number of cases18 (30%) were in the age group of 51-60 years, among males common age groups was 51-60 years (32%) and among females 31-40 years of age group (40%). Hoarseness was commonly found in labourer class 35 (58.3%). Among males this was commonest group comprising 33 (66%) and among females commonest was housewife category 5 (50%). Lower socio economic group was commonly noted among patients (53.3%), also in males (60%) and females (20%). Female majority belonged. To Moderate SES 8 (80%) Majority patients were from rural area 44 (73.3%). Smoking was commonly encountered habit among males 38 (63.3%). Among females, majority had no habit 60%. Least habit was vocal abuse 5 (10%). Along with hoarseness (100%) other symptom with which patient presented were dysphagia 34 (56.7%), and least associated complaints was reflux symptoms & fever and cough each 1.7% Maximum number of patients presented with hoarseness of voice with duration of 6-9 months about 27 cases (45%). On indirect laryngoscopic examination commonest finding was laryngeal growth 32 (53.3%) Microlaryngoscopic examinations and direct laryngoscopy 6 (18.2%) and sputum for AFB in 10 (30.3%). Among 45 histopathological studies, commonest finding was squamous cell carcinoma 32 (71.1%). Our study showed following aetiological factors for hoarseness of voice. Laryngeal malignancies : 53.3%, Chronic laryngitis : 1.7% , Vocal cord paralysis : 20%, Vocal cord nodules : 5%, Vocal cord papilloma : 1.7%, Vocal cord polyp : 11.7%, Bilateral abductor palsy : 3.3%, Laryngeal trauma : 1.7%, Rhinosporidiosis of vocal cord : 1.7%. Laryngeal malignancy was the commonest cause of hoarseness of voice (53.3%) and males were commonly affected (58%). Smoking was noted in all male patients with malignancy (100%), along with alcohol consumption in 96.55% and chewing tobacco preparation in 37.9% of cases. Vocal cord Palsy was next common cause for hoarseness of voice (20%) and was found 20% among males and 20% among females, with male to female ratio 5:1. No treatment was given for vocal cord paralysis (20%) cases. Vocal cord palsy (20%) & bilateral abductor (3.3%) palsy. On follow up showed no change in case of abductor palsy2 (100%) & 10 cases (83.3%) of vocalcord palsy. But 2 cases (16.67%) of vocalcord Palsy Improved. 7 cases (11.7%) of vocalcord polyp was found and it was common in males (10%). Vocalcord polyps were treated with MLS surgery and improvement noted in 100% of cases. 3 case of vocal nodule (5%) Improvement voice in vocal nodules was 100%. It was common among male patients (4%) with male to female ratio 2:1. Bilateral abductor palsy 3.3%, among this male 1(2%) and female 1(10%) with male to female ratio 1:1. 1 cases of vocal fold papilloma (1.7%) were treated with MLS excision, improvement of voice present in (100%).Males were commonly affected about 2%. 1 case (1.7%) of laryngeal trauma was treated MLS & improvement was 100%. 1 case each 1.7% presented with chronic laryngitis and rhinosporidiosis. Chronic laryngitis (1.7%) was treated medically and there was 100% improvement in voice. Rhinosporidiosis was treated with MLS excision and 100% improvement in voice noted. Patients who had laryngeal malignancies (53.3%) were subjected to radiotherapy and hoarseness worsened in all cases. Tracheostomy was done in 15 cases. Among 60 cases 26.7% showed improvement of voice, (53.3%) showed worsening and 20% showed no change in voice after treatment. Based on vocal professional level classification, majority 63.3% belonged to level IV category non vocal non Professional. Our conclusion is middle aged and elderly patients presenting with hoarseness of voice of more than two-week duration along with habits of smoking alcohol consumption and chewing tobacco preparation, malignancy must be ruled out. Appropriate treatment after proper diagnosis is key to treatment and if patient follows up regularly voice can be restored to near normal.

Item Type: Thesis (Masters)
Additional Information: Reg.No.22102231
Uncontrolled Keywords: hoarseness of voice, Aetiopathological study.
Subjects: MEDICAL > Otolaryngology
Depositing User: Devi S
Date Deposited: 27 Mar 2020 10:13
Last Modified: 27 Mar 2020 10:13

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