Differential Diagnosis for Dysphagia and Hoarseness
Single Most Likely Diagnosis
- Laryngopharyngeal Reflux (LPR): This condition is characterized by the backflow of stomach acid into the throat, causing irritation and inflammation. It is a common cause of both dysphagia (difficulty swallowing) and hoarseness due to its direct impact on the throat and vocal cords.
Other Likely Diagnoses
- Gastroesophageal Reflux Disease (GERD): Similar to LPR, GERD involves the reflux of stomach acid, but it primarily affects the esophagus. It can cause dysphagia and, less commonly, hoarseness if the reflux reaches the upper esophagus and throat.
- Thyroid Disorders: Conditions such as a thyroid goiter or thyroid cancer can cause mechanical obstruction or compression of the esophagus and trachea, leading to dysphagia and hoarseness.
- Vocal Cord Lesions: Polyps, nodules, or cysts on the vocal cords can cause hoarseness. If these lesions are large enough, they might also contribute to dysphagia by obstructing the passage of food.
Do Not Miss Diagnoses
- Esophageal Cancer: Although less common, esophageal cancer is a critical diagnosis not to miss due to its poor prognosis if not caught early. It can cause progressive dysphagia and, in advanced stages, hoarseness if the tumor invades nearby structures.
- Mediastinal Masses: Masses in the mediastinum, such as lymphomas or metastatic cancers, can compress the esophagus and trachea, leading to dysphagia and hoarseness.
- Aortic Aneurysm or Dissection: A large aneurysm or dissection of the aorta can compress adjacent structures, including the esophagus and recurrent laryngeal nerve, causing dysphagia and hoarseness.
Rare Diagnoses
- Amyotrophic Lateral Sclerosis (ALS): A progressive neurological disease that can affect the muscles used for swallowing, leading to dysphagia. Hoarseness might occur due to involvement of the vocal cord muscles.
- Myasthenia Gravis: An autoimmune disorder that can cause weakness in various muscles, including those used for swallowing and vocal cord function, leading to dysphagia and hoarseness.
- Sarcoidosis: A condition that can cause inflammation in various parts of the body, including the esophagus and larynx, potentially leading to dysphagia and hoarseness.