Throat
Problems
Hoarseness
There are a number of conditions that can lead to a change in the quality
of the human voice leading to hoarseness. Before I explain some of the causes
of hoarseness of the throat I will briefly explain the anatomy of the upper airway.
Here is a picture
that compares the anatomy of the upper airway of a human to the anatomy in a chimpanzee
(use the return key in the left upper corner of your screen to return
to this page). The point that was made in this illustration is that in
humans the crossing of the food pathway is anatomically much lower than in the
chimpanzee. Also the chimpanzee has a much bigger lid (called the epiglottis)
that protects the upper opening of the larynx from choking. As humans depend on
protective reflexes to prevent choking spells, we need to be aware of the following
facts: - We need to realize that we can only do one thing at
a time: either eat or breathe. If we want to breathe while swallowing or if we
want to swallow while breathing, we likely will choke (meaning that food particles
want to enter into the larynx causing us to cough).
- When the Central
Nervous System is suppressed, as after too much alcohol, during multidrug interaction
in the elderly or during a period of unconsciousness, the protective reflexes
do not work well any more and there is a danger of aspiration pneumonia.
Here
are some common reasons for hoarseness of the throat (modified according to Ref.
2, p. 1760). I have listed them in this table and will comment briefly on each
of these conditions right after. You can use the links to get there faster.
| | Disease
condition: | Comments:
| | malformations
| congenital macroglossia or craniofacial
anomalies | | infections
| croup, laryngitis, epiglottitis, fungal
larynx infection, diphtheria | | granulomatous
diseases | tuberculosis, lupus, leprosy,
syphilis | | angioedema | acute
swelling due to allergies | | gastroesophageal
reflux disease | GERDcan lead
to micro aspirations of gastric acid into the upper larynx during deep sleep.
| | voice
abuse | vocal fold nodules are caused
by this, called "singer's nodules", "preacher's nodules" or
"screamer's nodules" | | vocal
cord polyps, granulomas and cysts | all
of these changes occur because of voice abuse; intubation during surgery can cause
granulomas | | vocal
cord paralysis | cancer, neck surgery
and infection are common causes | | neurological
illness | Parkinsons disease, myasthenia
gravis, ALS (Lou Gehrig disease) | | foreign
body aspiration | sometimes masked as an
asthma attack (sudden wheeze with breathing) |
| larynx
cancer | cancer and other tumors change
voice |
Malformations With the importance of head and neck
shape for the proper swallowing and breathing mechanism as indicated above, it
is easy to see that a congenitally large tongue (macroglossia) or a malformed
head shape (craniofacial anomaly) can cause problems. A pediatric maxillofacial
surgeon and pediatric ENT surgeon likely should assess the child as soon as possible
after birth. Some of the problems can wait, others have to be fixed right away
(Ref. 2, p. 1761).
Infections Viral
infections cause croup and laryngitis.
Haemophilus influenzae and other bacteria can cause epiglottitis,
which has been dealt with under this link. Fungal
infections can also lead to hoarseness of the throat. Diphtheria,
although rare in countries that have childhood vaccination programs, is still
very common in development countries and can be a serious cause of hoarseness
of the throat. Further symptoms, findings and treatment are dealt with under this
link (Ref. 2, p. 1762).
Granulomatous
diseases With granulomatous diseases one of the first signs
is hoarseness of the voice, but shortly after there is an chronic presistent cough
that develops. There might be coughing up of blood as well, as the granulomatous
tissue around the pharynx tends to bleed. Tuberculosis
is the most common infectious granulomatous disease and has been dealt with under
the indicated link. Other diseases and their links are syphilis,
leprosy and lupus
(Ref. 2, p. 1762).
Angioedema Urticarial
rashes and angioedema are allergic conditions where highly active circulating
immunoglobulin IgE antibodies suddenly bind to an allergen like peanut protein
causing immediate swelling and in the throat a possible acute airway obstruction.
Similar abrupt angioedema reactions can take place with allergies to bees or wasps.
It is important for these individuals to carry medical alert bracelets and for
onlookers to call 911 for the emrgency response team. Adrenaline by inhalation
or 0.5 ml of 1:1000 dilution subcutaneously can be life saving the sooner it is
given (Ref. 2, p. 1762).
Gastroesophageal
Reflux Disease (GERD) With an incompetent sphincter in the
lower esophagus gastric acid can flow up the esophagus
and at night when the patient is deeply asleep there is a danger that acid might
be aspirated. Even a small amount of acid at the entrance to the larynx can lead
to devastating laryngeal scarring, granulomas, polyps and cysts (Ref. 2, p. 1762). Voice
abuse With strain of the voice in professional speakers, teachers,
sport coaches etc., structural changes of the vocal folds are happening. These
structural changes lead to a monotonous, breathy and harsh voice. If speech therapy
and voice training is instituted at this stage this condition is reversible (Ref.
2, p. 1763).
Vocal
cord paralysis The vocal cords are supplied by the laryngeal nerves.
If there is disruption from cancer, or if surgery to the thyroid gland inadvertently
destroys the nerve, the voice becomes hoarse or gets otherwise changed.
Throat
Cancer This topic has been dealt with under this link. In about
30% of cases of hoarseness there is an underlying tumor, either a primary larynx
cancer or a secondary cancer that metastasized into the larynx from another original
site (Ref. 2, p. 1766).For those of you who like to see a picture of larynx cancer,
but do not have access to the chapter on larynx cancer I am repeating a link
to a site with a picture of laryngoscopy findings regarding two throat cancers
.
| |
