Differential Diagnosis for Hoarseness

The patient's symptom of hoarseness can be caused by a variety of conditions affecting the larynx or the nerves controlling the vocal cords. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Acute Laryngitis: This is often the most common cause of hoarseness, usually resulting from a viral upper respiratory infection. It leads to inflammation of the larynx, affecting the vocal cords and causing hoarseness.

• Other Likely Diagnoses

  • Gastroesophageal Reflux Disease (GERD): Stomach acid reflux can irritate the vocal cords, leading to hoarseness. This condition is common and can be exacerbated by diet, obesity, and other factors.
  • Vocal Cord Lesions (e.g., polyps, nodules): These are growths on the vocal cords that can cause hoarseness. They are often related to voice misuse or overuse.
  • Allergies: Postnasal drip from allergies can irritate the vocal cords, leading to hoarseness.
  • Thyroid Conditions: Both hypothyroidism and hyperthyroidism can affect the voice, leading to hoarseness.

• Do Not Miss Diagnoses

  • Laryngeal Cancer: Although less common, cancer of the larynx can cause hoarseness. It's crucial to rule out this diagnosis, especially in smokers or those with a history of significant alcohol use.
  • Neurological Conditions (e.g., Parkinson's disease, stroke): Certain neurological disorders can affect the nerves controlling the vocal cords, leading to hoarseness.
  • Vocal Cord Paralysis: This can result from nerve damage, often due to surgery, trauma, or a tumor, and can cause significant voice changes, including hoarseness.

• 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 that can cause inflammation in various parts of the body, including the larynx, resulting in hoarseness.
  • Amyloidosis: A group of diseases that result from the abnormal accumulation of amyloid proteins in various tissues, which can rarely affect the larynx and cause hoarseness.

Each of these conditions has a different set of risk factors, symptoms, and diagnostic approaches. A thorough history, physical examination, and potentially laryngoscopy or other diagnostic tests are necessary to determine the underlying cause of the patient's hoarseness.