Hoarseness (Dysphonia): Or something else? Differential Diagnosis

Congenital malformations, deformities, and chromosomal abnormalities (Q00-Q99).

  • Laryngocele – dilated blind sac located in the larynx.

Respiratory system (J00-J99)

  • Acute laryngitis (inflammation of the larynx).
  • Chronic hyperplastic/atrophic laryngitis – form of chronic laryngitis.
  • Epiglottitis (inflammation of the epiglottis).
  • Laryngeal abscess – encapsulated collection of pus on the larynx.
  • Peritonsillar abscess (PTA) – spread of inflammation to connective tissue between tonsil (tonsils) and constrictor pharyngis muscle with subsequent abscessation (collection of pus); predictors of peritonsillar abscess: male sex; age 21-40 years and smoker [unilateral sore throat/severe pain, trismus (lockjaw), potty voice and deviation of uvula (uvula of palate)]
  • Pharyngitis (pharyngitis).
  • Reinke’s edema – edema of the vocal fold margin in the so-called Reinke’s space, a slit-shaped space between the epithelium and the underlying connective tissue.
  • Sinusitis (sinusitis)

Endocrine, nutritional and metabolic diseases (E00-E90).

Infectious and parasitic diseases (A00-B99).

  • Diphtheria – infectious disease caused by Corynebacterium diphtheriae.
  • Infections with streptococci or other unspecified pathogens.
  • Influenza (flu)
  • Mononucleosis (Pfeiffer’s glandular fever)
  • Scarlet fever
  • Syphilis (lues, venereal disease)
  • Tuberculosis
  • Worm diseases (Ancylostomatidae)

Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).

  • Gastroesophageal reflux disease (synonyms: GERD, gastroesophageal reflux disease; gastroesophageal reflux disease (GERD); gastroesophageal reflux disease (reflux disease); gastroesophageal reflux; reflux esophagitis; reflux disease; Reflux esophagitis; peptic esophagitis) – inflammatory disease of the esophagus (esophagitis) caused by the pathological reflux (reflux) of acid gastric juice and other gastric contents.
  • Laryngopharyngeal reflux (LRP) – “silent reflux” in which the cardinal symptoms of gastroesophageal reflux, such as heartburn and regurgitation (backflow of food pulp from the esophagus into the mouth), are absent.

Musculoskeletal system and connective tissue (M00-M99).

Neoplasms – tumor diseases (C00-D48).

  • Bronchial carcinoma (lung cancer)
  • Intramuscular laryngeal lipoma – fatty tumor (lipoma) located in the muscles (intramuscular) of the larynx (larynx); results in slowly progressive (progression) dysphonia
  • Laryngeal granuloma – benign neoplasm of the larynx.
  • Laryngeal carcinoma (cancer of the larynx) [about 30% of all head and neck tumors; about two-thirds of laryngeal tumors affect the vocal folds].
  • Mediastinal tumors, unspecified.
  • Neoplasms of the neck such as tumors of the base of the tongue and tonsils.
  • Esophageal cancer (cancer of the esophagus) due to recurrent paresis (vocal cord paralysis).
  • Papillomas (benign tissue neoplasms) – these form in the larynx (larynx) at or around the vocal folds; a distinction is made between juvenile (between the ages of two and four) and adult recurrent papillomatosis (between the ages of 20 and 40)
  • Thyroid carcinoma (thyroid cancer).
  • Vocal fold nodules (also called singer or crying nodules).
  • Vocal cord polyps

Psyche – nervous system (F00-F99; G00-G99)

  • Myasthenia gravis (MG; synonyms: myasthenia gravis pseudoparalytica; MG); rare neurologic autoimmune disease in which specific antibodies against the acetylcholine receptors are present, with characteristic symptoms such as abnormal load-dependent and painless muscle weakness, an asymmetry, in addition to local also a temporal variability (fluctuation) in the course of hours, days, resp. Weeks, an improvement after recovery or rest periods; clinically can be differentiated a purely ocular (“affecting the eye”), a faciopharyngeal (face (Facies) and pharynx (pharynx)) emphasized and a generalized myasthenia; about 10% of cases already show a manifestation in childhood.
  • Psychogenic voice disorder – mostly affects the female sex; age of manifestation: 20 to 40 years of age; Symptomatology: sudden severe hoarseness to voicelessness / laryngeal sound such as throat clearing is possible; causative is often a drastic psychologically stressful event.
  • Recurrent paresis (vocal cord paralysis) [usually iatrogenic after surgery or trauma in the area of the vagus nerve/recurrent paresis].

Symptoms and abnormal clinical and laboratory findings not classified elsewhere (R00-R99).

  • Voice disorders such as functional dysphonia/aphonia, dyskinetic voice disorder; nonspecific symptoms of functional dysphonia include globus sensation (feeling of lumpiness), burning, scratching, feeling of mucus, and compulsion to clear throat
  • Overload of the voice (eg due toshouting, screaming).

Injuries, poisoning and other consequences of external causes (S00-T98).

  • Laryngeal injuries of all types (e.g., after bronchoscopy/lung endoscopy), including scalding, chemical burns

Medication

  • ACE inhibitor (captopril)
  • Asthma sprays (their particles can settle on the vocal cords).
  • Cromoglicic acid
  • Hormones
    • Anabolic steroids
    • Androgens

Further

  • Noxae (smoking; irritant gases).
  • Trauma (e.g., after intubation/insertion of an endotracheal tube (called a tube for short; it is the breathing tube, a hollow plastic probe inserted into the trachea (windpipe))