Table 1. Causes and characteristics of hoarseness.
| Pathology | Proportion of all cases | Typical symptoms | Treatment | Evidence | ||
|---|---|---|---|---|---|---|
| Functional dysphonia | Hyperfunctional dysphonia | 30% | Hoarseness with vocal strain | Voice therapy | 1a/A | |
| Secondary manifestation of functional dysphonia | Vocal cord nodules | Included in benign tumors (10.7–31%) | Hoarseness with vocal strain | Voice therapy (phonosurgery) | 1a/A | |
| Organic dysphonia | Laryngitis | Acute | 42.1% | Hoarseness. infection | No medicinal treatment. self-limiting | 1a/A |
| Chronic | 9.7% | Constant hoarseness. dysphonia. throat _sensations. compulsion to clear throat | Avoidance of noxae. laryngostroboscopic _monitoring | 4/X | ||
| Benign tumors | Polyps/cysts | 10.7–31% | Hoarseness. reduced volume of voice. _vocal fatigue | Phonosurgery. if applicable voice therapy | 2a/B | |
| Reinke edema | Hoarseness. vocal fatigue. deep voice | Avoidance of noxae. phonosurgery. _if applicable voice therapy | 2a/B | |||
| Recurring _papillomatosis | Hoarseness. dyspnea | Phonosurgery | 2a/B | |||
| Vocal cord malignancies | 2.2–3% | Hoarseness as early symptom | (Laser) surgery. radiotherapy | 2a/B | ||
| Vocal cord scarring | n.d. | Constant hoarseness. quiet voice | Voice therapy (phonosurgery) | 4/X | ||
| Presbyphonia | 2% | Hoarseness. high-pitched voice | Voice therapy. phonosurgery | 2a/B | ||
| Manifestation of internal_ disease | Laryngopharyngeal reflux | Included in chronic laryngitis (9.7%) | Only slight hoarseness. throat sensations _predominantly at night | With signs of reflux: PPIs | 2b/C | |
| Without signs of reflux: no PPIs | 2a/B | |||||
| Tuberculosis | n.d. | Dyspnea. cough | Tuberculostatic treatment | 3/D | ||
| Rheumatoid diseases | Rheumatoid arthritis | n.d. | Hoarseness. dyspnea. or dysphagia. _depending on site | Antirheumatic treatment | 3/D | |
| Collagenoses (systemic lupus erythematosus) | n.d. | |||||
| Vasculitides (Wegener disease) | n.d. | |||||
| Sarcoidosis | n.d. | |||||
| Amyloidosis | n.d. | Hoarseness. dyspnea. or dysphagia. _depending on site | Phonosurgery. internal / hematological _treatment | 3/D | ||
| Lymphoma | n.d. | Dysphonia. dyspnea | Internal / hematological treatment | 4/X | ||
| Neurological diseases | Vocal cord paresis | 2.8–8.0% | Hoarseness. impaired speech breathing | Voice therapy. phonosurgery | 1a/A. 2a/B | |
| Spasmodic dysphonia | n.d. | Variable hoarseness | Administration of botolinumtoxin A | 2a/B | ||
| Vocal cord dysfunction | n.d. | Hoarseness during an episode of respiratory distress (few seconds) | Discuss with patient. breathing therapy. _psychotherapy | 4/X | ||
| Psychogenic dysphonia | 2–2.2% | Sudden hoarseness (hours or days) | Psychological and psychosomatic treatment. psychotherapy | 4/X | ||
Etiological classification of dysphonias according to causes. typical symptoms and characteristics of hoarseness. showing each cause’s percentage contribution to the total. Phonosurgery is an operative intervention to improve the voice. usually using microinstruments inserted transorally via a laryngoscope. sometimes by means of laser. n.d.. no data or prevalence <1%; PPIs. proton pump inhibitors (1, 2. e2-e5)