Journal of Otology & RhinologyISSN: 2324-8785

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Research Article, J Otol Rhinol Vol: 4 Issue: 5

Causes of Hoarseness in Benin City, Nigeria

Paul Oserhemhen Adobamen*
Ear, Nose, Throat, Head and Neck Surgery Department, University of Benin Teaching Hospital, Benin city, Nigeria
Corresponding author : Dr. Paul Oserhemhen Adobamen
P.O. BOX 6741, Benin City, Edo State, Nigeria
Tel: +234 802 420 6872
E-mail: [email protected]
Received: June 16, 2015 Accepted: August 28, 2015 Published: September 04, 2015
Citation: Adobamen PO (2015) Causes of Hoarseness in Benin City, Nigeria. J Otol Rhinol 4:5. doi:10.4172/2324-8785.1000245

Abstract

Study background: A good number of cases of hoarseness are seen in the Ear, Nose, Throat, Head and Neck (ENTH & N) Surgery clinic of the University of Benin Teaching Hospital (UBTH), Benin City, Nigeria. Hoarseness has different causes, some of which are life-threatening; this study was done to determine the causes.

Material and methods: A prospective study of all patients that presented with hoarseness in our clinic between January, 2009 and December, 2010 was carried out. The patients’ history and examinations findings were noted.

Results: Eighty six patients; 49 males and 37 females presented with hoarseness. Ages ranged from 2.17years to 90.00 years, with an average age of 45.67 years. The main causes of hoarseness were; inflammatory (27.91%), carcinoma of the larynx (13.96%) and tuberculous laryngitis (9.30%).The duration of hoarseness before presentation in the hospital ranged from 1 day to 5475 days with an average duration of 539.06 days. Description of the characteristics of hoarseness was dependent on the aetiological factors; with cancer of the larynx presenting with progressive, unremitting or constant hoarseness while inflammatory lesions presented more with intermittent hoarseness.

Conclusion: Chronic laryngitis, cancer of the larynx and tuberculous laryngitis were the commonest causes of hoarseness in this study.

Keywords: Causes; Hoarseness; Benin City; Nigeria; Chronic laryngitis; Laryngeal cancer; Tuberculous laryngitis; Aetiology

Keywords

Causes; Hoarseness; Benin City; Nigeria; Chronic laryngitis; Laryngeal cancer; Tuberculous laryngitis; Aetiology

Introduction

A normal voice is clear, audible, stable, not easily fatigued and appropriate for gender and age [1]. Hoarseness is defined as roughness, or breathy quality to the voice [2]. The process of voice production involves the production of sound by the action of expired air on the vocal cords and modification by the pharynx, nose, mouth, tongue, lips and chest. Chevalier Jackson pointed the significance of hoarseness as a signal of distant malignancy and other conditions [3]. Benign causes of hoarseness appear to be more common than malignant causes, but it is difficult to say whether the cause of a particular case of hoarseness is benign or malignant; this widespread belief that hoarseness is often due to a benign cause gives room for laxity in appropriately managing malignant cases of hoarseness, with grave sequelae [4]. Folks that frequently use their voices such as teachers, pastors, hawkers frequently present with hoarseness, but a study have shown that all age groups and both sexes can be affected [5]. In the UK about 50,000 cases of hoarseness are seen yearly [6].
A good number of patients with hoarseness from varied causes present at UBTH [7]. A good history with relevant laryngological examination is needed to make a diagnosis. This should be timely as life-threatening conditions cause hoarseness and should be diagnosed early for quick treatment. Previous studies on hoarseness were done in Western Nigeria about 7-8 years ago [8-12], but a study on the aetiological factors for hoarseness has not been done in the Mid-western region of Nigeria. This study was therefore carried out to determine the cause of hoarseness in this region and to serve as a baseline for policies for quick therapeutic intervention of patients with hoarseness.

Materials and Methods

A prospective study of all patients presenting with hoarseness in the ENTH&N Surgery clinic of UBTH from January 2009 to December, 2010. Patients with hoarseness were evaluated with a detailed history, general examination and laryngeal examination with the aid of a laryngeal mirror and or flexible fibre-optic laryngoscope done for them. Uncooperative patients for mirror or fibre-optic laryngoscopic examination or who needed laryngeal tissue biopsy to ascertain the aetiology of the hoarseness, had direct laryngoscopy/ micro-laryngoscopy using a Klein Sasser rigid laryngoscope under general anaesthesia. All excised tissues were sent for histology. Data retrived were age, sex, aetiology, duration of hoarseness and the description of the hoarseness by patients. Results were analyzed and shown in descriptive tables. Hoarseness was constant (persistent) if it was was non-remitting and unproductive. It was intermittent if it was “on and off”. Progressive referred to hoarseness that got worse with time while unremitting was used when it was always present. It was termed unspecified if the patient could not describe it.

Results

Eighty six patients; 49 males and 37 females presented with hoarseness with a male to female ratio of 1.32 to 1. Ages ranged from 2.17 years to 90.00 years, with an average age of 45.67 years.
Table 1 showed causes of hoarseness with inflammatory (27.91%), carcinoma of the larynx (13.96%) and tuberculous laryngitis (9.30%) as main causes. Table 2 showed the duration of hoarseness before presentation in the hospital ranging from 1 day to 5475 days with an average of 539.06 days. Table 3 showed the description of the characteristics of hoarseness depending on the aetiological factors.
Table 1: Aetiological factors for hoarseness.
Table 2: Duration of hoarseness before presentation.
Table 3: Description of the characteristics of hoarseness.

Discussion

The male to female ratio of patients with hoarseness of 1.32 to 1 is comparable to the finding of Nwaorgu and co-workers [10] with a male to female ratio of 1.38 to 1. It is at variance with the work of Alabi and co-workers [12] with a male to female ratio of 1 to 3.64.More females to males (2.5 to 1) in the total sampled population is responsible for the discrepancy in Alabi’s study. The average age of 45.67 years, in this study is comparable with the mean age of 46.98years as observed by Nwaorgu and co-workers in Ibadan [10]. Again this is at variance with the work by Alabi with a mean age of 36 years. Alabi’s work was targeted at professional teachers who are usually within the above age bracket, unlike this and Nwaorgu’s which were more of community works. In this study, chronic laryngitis (27.91%), carcinoma of the larynx (13.96%) and tuberculous laryngitis (9.30%) were the leading ranked causes of hoarseness. Chronic laryngitis predisposed by atmospheric pollution, tobacco smoking and common respiratory tract infections was the commonest cause of hoarseness in Nigeria [8-12], Faisalabad, India [13]. Chronic laryngitis is due to bacterial, fungi and viral agents leading to fibrosis and scarring with resultant hoarseness.
Twelve (13.96%) cases of hoarseness were due to squamous cell carcinoma of the larynx. It is advised that patients with hoarseness of greater than 3 weeks duration should report for medical checkup, 10 but most of the cases due to cancer presented quite late [8-9,14], despite hoarseness been a main presenting symptom. Nwaorgu in 1996 [15] and 2004 [10] reported 29.5% and 24.2% respectively as the percentage of hoarseness due to laryngeal carcinoma in Ibadan. Okeowo reported cancer of the larynx as 11.9% of hoarseness in Nigeria in 1977 [8]. The percentage of laryngeal carcinoma causing hoarseness is comparable in the index and Okeowo’s studies, unlike the high percentage in Ibadan. Nwaorgu attributed the high prevalence of cancer of the larynx causing hoarseness in Ibadan to the average consumption of 20 sticks of cigarette and variable amounts of alcohol daily for over 15 years in 43% of the patients in his study [10].
Despite all the prophylactic and therapeutic measures against tuberculosis in Nigeria, 9.30% of hoarseness is from tuberculous laryngitis. This implies pulmonary tuberculosis in these patients; as laryngeal tuberculosis is due to pulmonary kocks in Ibadan [15]. Tuberculous laryngitis was responsible for 10% of hoarseness in Faisalabad [13], 47% in a report by the Journal of Pakistan Medical Association [16], 3.9% by Okeowo [8], 6.8% by Nwaorgu [11], 1.6% by Nwaorgu and co-workers [10]. Nwaorgu [10] earlier pointed to the fact that tuberculosis, a major public health concern in developing regions mimicks laryngeal cancer, leading to late diagnosis. It is a danger to the otolaryngologist, who may be infected if appropriate prophylaxis is not taken [17,18].Two patients presented with severe epithelial dysplasia while one patient was diagnosed of leucoplakia on the vocal cord. Leucoplakia are white patches on the vocal cord; with a malignant transformation rate of between 1% to 40% [19]. Dysplastic lesions are precancerous. These cases need early diagnosis and treatment for curative intent. The causes of hoarseness are as in Table 1. After diagnosis of hoarseness the appropriate therapeutic measures were instituted.
The average duration before presentation was 539.06 days as in Table 2, which is long relative to the gravity of the sequelae, as in the cancerous cases. Other workers mentioned above corroborated this finding. Table 3 showed the descriptive characteristics of hoarseness in relation to the aetiological factors. Of particular importance is the characteristic of hoarseness in cancer of the larynx, which was described as progressive, unremitting, constant or getting worse by all the patients with laryngeal tumours apart from the 4 cases that were unspecified. This symptom should be asked for and noted for its significance as ominous for cancer in patients with hoarseness. Inflammatory hoarseness is intermittent while traumatic hoarseness is indicated by the history.
The main causes of hoarseness in this study should be looked out for and precautionary and curative measures quickly put in place to avoid untoward sequelae. The characteristics of the hoarseness may be suggestive of the aetiology. Primary care and family physicians need to be armed with this vital information as patients first consult them with hoarseness. Public health physicians, nurses and other healthcare workers should be aware of these facts for health education campaigns and preventive strategies.

Conclusion

Chronic laryngitis, cancer of the larynx and tuberculous laryngitis were the commonest causes of hoarseness. The average duration of hoarseness before presentation was 539.06 days. Hoarseness due to cancer was described as progressive, unremitting or constant while inflammatory lesions caused intermittent hoarseness.

References

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  2. McGlashan J (2008) Disorders of the voice. In: Browning GG, Burton MJ, Clarke R, Hibbert J, Jones NS, Lund VJ (Eds). Scott-Brown’s Otorhinolaryngology, Head and Neck Surgery.7th Edition. Edward Arnold Publishers Ltd, London.

  3. Parikh NP (1991) Aetiological study of 100 cases of hoarseness of voice. Indian Journal of Otolaryngology, Head and Neck Surgery 41: 71-73.

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  16. Iqbal K, Udaipurwala IH, Khan SA, Jan AA, Jalisi M (1996) Laryngeal involvement in pulmonary tuberculosis. J Pak Med Assoc 46: 274-276.

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