Differential Diagnosis for Hoarse Voice

The following is a differential diagnosis for a hoarse voice and inability to speak freely, categorized for clarity.

• Single Most Likely Diagnosis

  • Acute Laryngitis: This is the most common cause of a hoarse voice, often resulting from a viral infection, overuse of the voice, or irritation from allergies or reflux. The symptoms typically include hoarseness, sore throat, and sometimes a cough.

• Other Likely Diagnoses

  • Vocal Cord Nodules or Polyps: These are growths on the vocal cords that can cause hoarseness and voice changes, especially in individuals who use their voice heavily, such as singers or teachers.
  • Gastroesophageal Reflux Disease (GERD): Stomach acid reflux can irritate the vocal cords, leading to hoarseness and discomfort.
  • Allergies: Postnasal drip from allergies can irritate the throat and vocal cords, causing hoarseness.
  • Thyroid Disorders: Both hypothyroidism and hyperthyroidism can affect the voice, leading to hoarseness.

• Do Not Miss Diagnoses

  • Laryngeal Cancer: Although less common, laryngeal cancer can present with persistent hoarseness and should be considered, especially in smokers or those with a history of heavy smoking.
  • Neurological Disorders (e.g., Parkinson’s Disease, Stroke): Certain neurological conditions can affect the nerves controlling the vocal cords, leading to voice changes, including hoarseness.
  • Epiglottitis: This is a rare but potentially life-threatening condition where the epiglottis becomes inflamed, which can cause severe throat pain, hoarseness, and difficulty speaking or swallowing.

• Rare Diagnoses

  • Relapsing Polychondritis: A rare autoimmune disorder that can cause inflammation of the cartilages of the body, including those in the larynx, leading to hoarseness.
  • Sarcoidosis: A condition where inflammatory cells form in different parts of the body, including the lungs and lymph nodes, and can rarely affect the larynx, causing hoarseness.
  • Amyloidosis: A group of diseases that result from the abnormal accumulation of a protein called amyloid, which can deposit in the larynx and cause hoarseness.