List the aetiology, diagnostic investigations and management of hoarseness Laryngitis Smoking Hoarseness is a red flag in smokers. If present with this happening for 6 weeks or more, should be seen by an ENT surgeon. Allergies Inhaled corticosteroid use Voice overuse Nodules and polyps in on the free edge of the vocal cords -> prevent full closure and giving a breathy and harsh voice. Commonly found in professionals who rely on their voices for their livelihood. For example: Teachers Lawyers Singers Related to poor technique of voice production Cured with voice therapy. Surgery may be needed Muscle Tension Dystonia NS disorder causing uncontrolled muscle contractions -> muscles around the larynx become tense. Different to dyskinesia (involuntary muscle movements). Clinical features: Painful Worse when using the muscles. Hand and feet dystonia Blepharospasm -> involuntary eyelid closure due to excessive spams. Medications. Investigations: Levodopa responsiveness. MRI Serum ceruloplasmin 24-hour urine copper Genetic testing Management: Anticholinergics, antispasmodic and botulin toxin injections. Relive symptoms. Physiotherapy Targeted exercises and stretching to improve muscle functions and reduce abnormal postures. Deep brain stimulation Reserved for severe and refractory cases. Involves implanting electrodes in specific brain regions to modulate neural activity. Reinke’s Edema Collection of fluid in the subepithelial layer of the vocal cords. At superficial laminal propria of the true vocal cords caused by chronic inflammation and irritations secondary to smoking. Due to the vocal cords having poor lymphatic drainage -> hence at a greater risk. Irritation of vocal cords by smoking, voice abuse, acid reflux and rarely hypothyroidism. Clinical features: Hoarseness Low pitched Harsh voice Investigations: Laryngoscopy: Bilateral swelling of the true vocal cords. Management: Controlling risk factors: Smoking cessation Reflux management Conservative therapy: Speech therapy -> but do not eliminate fluid build up but help with reducing some symptoms. Restoring normal voice function: Microsurgical removal in cases in which voice function is dissatisfactory despite conservative treatment.