Differential Diagnosis for Sudden Loss of Voice
The patient's complaint of losing her voice for the past 2 weeks can be approached by considering various potential causes, categorized for clarity and urgency.
Single Most Likely Diagnosis
- Acute Laryngitis: This is often the most common cause of sudden voice loss, typically resulting from a viral infection. The inflammation of the larynx leads to hoarseness or complete loss of voice. The duration of 2 weeks fits within the timeframe for acute laryngitis, which usually resolves on its own with rest and hydration.
Other Likely Diagnoses
- Vocal Cord Lesions (e.g., nodules, polyps): Prolonged voice misuse or overuse can lead to the development of lesions on the vocal cords, causing voice changes or loss. These conditions are common in individuals who use their voice frequently, such as singers or teachers.
- Gastroesophageal Reflux Disease (GERD): Stomach acid reflux can irritate the vocal cords, leading to inflammation and voice changes. This condition is more likely in patients with a history of GERD symptoms.
- Allergic Laryngitis: Allergic reactions can cause swelling and irritation of the larynx, leading to voice loss. This might be considered in patients with known allergies or during peak allergy seasons.
Do Not Miss Diagnoses
- Laryngeal Cancer: Although less common, laryngeal cancer can present with persistent hoarseness or voice loss. It's crucial to rule out this diagnosis, especially in patients with risk factors such as smoking or a family history of cancer.
- Thyroid Disorders: Certain thyroid conditions can affect the nerves controlling the vocal cords, leading to voice changes. Hypothyroidism, in particular, can cause vocal cord swelling and hoarseness.
- Neurological Disorders (e.g., Parkinson’s Disease, Stroke): Neurological conditions can affect the nerves that control the vocal cords, leading to voice changes or loss. These conditions often present with other neurological symptoms.
Rare Diagnoses
- Relapsing Polychondritis: A rare autoimmune disorder that can cause inflammation of the cartilages, including those in the larynx, leading to voice loss.
- Sarcoidosis: A condition that can cause granulomas to form in various parts of the body, including the larynx, potentially affecting the voice.
- Foreign Body in the Larynx: Although more common in children, adults can also accidentally inhale objects that obstruct the larynx, causing sudden voice loss. This would typically be associated with a history of choking or coughing.