hoarse voice
Introduction
Introduction The hoarseness of the voice, or the hoarseness, means that the sound is lost when it is mellow and clear. Clinically, there are varying degrees of changes in sound quality. The lightest is called "hair", that is, there is a certain degree of sound quality change when the treble is high, and the sound becomes rough. "Sand" means that the sound quality of almost all tones has changed. Moderate changes in sound quality are called . At this time, in addition to the rough and impure quality, there is still a leak, indicating that the bilateral vocal cords have significant gaps in pronunciation. Severe sound quality changes are called "dumb", that is, the glottal gap is large when the sound is emitted, the vocal cords cannot vibrate, and only the whisper can be heard.
Cause
Cause
Reasons for hoarseness:
1, vocal cord polyps, vocal cord nodules, chronic laryngitis: patients with excessive pronunciation, such as long speech, shouting, a long history of crying, or improper use of sound, there will be continuous hoarse, and vocal nodules and The vocal cord polyps are often characterized by persistent hoarseness.
2, accompanied by sore throat, swallowing pain, after a cold and fever, may be acute pharyngitis. Severe sore throat, long-term unhealed, but also consider the possibility of laryngeal tuberculosis or malignant tumors.
3, the voice is dumb, even harsh, accompanied by a throat blockage, cough, blood in the sputum, accompanied by a mass of the neck, older patients should be alert to the possibility of laryngeal cancer.
4, foreign body sensation, accompanied by cough, sound easy to fatigue, or have a good time before going to bed, or often appear acid reflux, hernia, may also be reflux laryngitis, but some patients with reflux laryngitis also There is only one symptom.
5, other trauma, including dislocation of the ankle joint, and physical and chemical damage to the throat can lead to hoarseness.
Examine
an examination
Related inspection
Otolaryngology CT examination of oral endoscope
(1) Optical inspection:
Use a laryngoscope combined with a surgical microscope for laryngeal lesions or surgery.
(2) Dynamic laryngoscopy:
It is suitable for discriminating qualitative and functional lesions; determining the extent and extent of organic lesions; determining the type or severity of vocal cord paralysis, and distinguishing from ankle joint fixation, vocal cord inflammation, trauma, etc.; preliminary determination of the nature of vocal cord mass Conduct various tests and guide pronunciation training for sound workers.
(3) X-ray inspection:
1 lateral X-ray can observe the epiglottis anterior space, the epiglottic throat and the soft tissue of the lower jaw, and can perform vocal cord measurement and observe vocal cord paralysis.
2 laryngeal tomographic fault for clinical observation of vocal cord vocalization and presence or absence of occupational changes, mainly to observe the vestibular vestibule, ventricular septum, larynx, vocal cord and subglottic area orbital changes, while also viewing glottic closure and The two-way change of the glottis is open.
3 laryngeal CT examination, suitable for understanding the tissue anatomy of the throat and surrounding.
(4) Laryngeal electromyography:
It has important significance and identification for judging laryngeal muscle weakness or paralysis and pronunciation physiology.
(5) Gas dynamics inspection:
1 airflow test: If the glottic lesion occurs, the airflow rate is significantly reduced.
2 breath test: such as testing vital capacity, functional residual capacity, maximum ventilation, maximum respiratory flow, etc., to determine the role of breathing in the vocalization.
3 Sound intensity check.
4 glottal depression test: affected by gas flow and glottal impedance.
5 Simple sound test: sound time check and s/z ratio check to observe vocal cord lesions.
(6) glottal map and sound spectrum examination:
Reflects the dynamic changes in the speed and closure of the vocal cords on and off.
(7) B-mode ultrasound examination:
It can display the activity of the vocal cords, and determine whether the size, shape, location, and lesions of the lumps destroy the thyroid cartilage plate, thus providing important information for the operation.
(8) Pathological examination:
To determine the throat, especially the laryngeal cavity, there are new tumors or new tissue. The biopsy forceps must be taken under the laryngoscope to send a pathological examination to confirm the diagnosis.
(9) Auditory psychological examination:
The degree and nature of the hoarseness, especially the mute, can be expressed by the auditory impression, but the test is subjective and lacks stability.
Diagnosis
Differential diagnosis
1. Upper laryngeal nerve spasm: due to the sensation of the laryngeal nerve in the laryngeal nerve, and the movement of the ring muscle. Therefore, when the nerves on one side of the throat are paralyzed, the vocal cords lack tension, and when they are vocal, they are weak and easy to fatigue, and the sound quality is rough. During the examination, the vocal cord on the affected side was corrugated and fluttered up and down with the respiratory airflow.
2. Unilateral recurrent laryngeal nerve: pronunciation is hoarse, easy to fatigue, often showing cracking sound, speech, cough has a sense of air leak, late modern repayment, the side of the health side of the adduct is more than the midline close to the affected side, the voice is better.
3. bilateral recurrent laryngeal nerve spasm: sudden onset of vocal cord abduction on both sides can cause acute laryngeal obstruction. If the system is gradually ill, the patient may adapt without breathing difficulties and have little effect on the vocalization. If the adduction and outreach are flawed, the voice is hoarse and weak, and the speech is laborious and cannot last. The bilateral vocal cords are centered, slack, and the edges are still regular. Sudden aspiration, coughing and drainage difficulties.
4. Hyperthyroidism: Most of the myopathy is caused by excessive fatigue of the hyperthyroid muscle. Atrophy of nerve endings in the late stage of laryngeal muscle weakness can also be included. The pronunciation is low and thick, and it is easy to fatigue. The vocal cord movement adduction and abduction movements were normal. The glottis closes normally when the sound is heard, but a prismatic crack occurs between the membranes.
5. Interstitial tendon: the intercondylar muscle alone is rarely seen, often caused by bilateral nerve damage. Seen after an acute, chronic inflammation or noise from the throat. When pronounced, the vocal cords on both sides are closed and have a triangular slit at the rear end.
6. Unilateral ring sacral tendon: also known as the unilateral vocal cord median sputum, is one of the most common vocal cords. Mainly due to damage to the posterior branch of the laryngeal nerve ending branch. The symptoms were not obvious, and there was a temporary hoarseness. After the compensation, the symptoms disappeared. The affected side vocal cords were fixed in the median position. Subsequently, the muscles of the tendon lose muscle tension, causing the cartilage to bulge. Because the epiglottis wrinkles and loses the supporting effect, the affected side tendon cartilage advances.
