Differential Diagnosis for Dysphonia in the Aging Population

Dysphonia, or a change in voice, can be a concerning symptom in the aging population. The following differential diagnosis categorizes potential causes into four groups:

• Single Most Likely Diagnosis
  • Parkinson's Disease: Dysphonia is a common symptom of Parkinson's disease, affecting up to 90% of patients. The voice becomes softer, more monotone, and less expressive, which can be an early sign of the disease.
• Other Likely Diagnoses
  • Vocal Cord Lesions: Age-related wear and tear on the vocal cords can cause dysphonia. Lesions such as polyps, nodules, or cysts can develop and affect voice quality.
  • Thyroid Disorders: Hypothyroidism or hyperthyroidism can cause changes in voice, including hoarseness or breathiness.
  • Gastroesophageal Reflux Disease (GERD): Stomach acid reflux can irritate the vocal cords, leading to dysphonia.
• Do Not Miss Diagnoses
  • Laryngeal Cancer: Although less common, laryngeal cancer can present with dysphonia as an early symptom. It is crucial to rule out this diagnosis to ensure timely treatment.
  • Myasthenia Gravis: This autoimmune disorder can cause weakness in the vocal cord muscles, leading to dysphonia.
• Rare Diagnoses
  • Amyotrophic Lateral Sclerosis (ALS): ALS can cause dysphonia due to progressive muscle weakness, including the vocal cord muscles.
  • Multiple System Atrophy: This rare neurodegenerative disorder can affect the vocal cords, leading to dysphonia.
  • Vocal Cord Paralysis: Trauma, surgery, or neurological disorders can cause vocal cord paralysis, resulting in dysphonia.

Each of these diagnoses has a unique set of accompanying symptoms and requires a thorough evaluation to determine the underlying cause of dysphonia in the aging population.