Case Challenge: Diagnosing and Managing Dysphonia

Gordon H. Sun, MD, MS

Disclosures

June 19, 2018

Faltering Voice

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A 49-year-old reporter presented to his family physician for evaluation. The patient stated that he had been experiencing voice breaks more frequently over the past year. He tried drinking water and hot tea and honey at regular intervals without any success. He denied difficulty breathing or swallowing, hemoptysis, globus sensation, heartburn, or cough. He had no recent history of fevers or myalgia. There were no other known medical issues. His surgical history included an elective cholecystectomy under general anesthesia about a year and a half ago. He reports that he smokes cigars occasionally (approximately 1 per month), but denied drinking alcohol or use of illicit drugs. He was not taking any medications and had no known environmental or drug allergies. The patient noted that, although his job was stressful, it had not been any more so than usual.

Vital signs were unremarkable. On exam, he appeared comfortable and nontoxic, with no audible stridor. He had a hoarse but easily intelligible voice. The ocular and otoscopic exams were unremarkable. The oral examination demonstrated 1+ tonsils (obstruction less than 25% of space between tonsillar pillars) without exudate, midline uvula, mobile tongue, and no mucosal lesions. On neck exam, he had full cervical range of motion and isometric neck muscle strength, the trachea was midline, and no palpable masses were felt. The remainder of the physical exam was unremarkable.

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