The major symptom of laryngeal disease is a change in the voice, especially the development of dysphonia, or hoarseness. Ask the following questions:
How long have you had the hoarseness?'' What seems to make it better? worse?'' ' 'Is there any time of day when it is worse?'' Have you had any surgery necessitating general anesthesia?'' ''Have you had any injury to your neck?''
Determine whether the patient is or was a smoker. Recent onset of hoarseness may result from impingement on the recurrent laryngeal nerve as it hooks around the left bronchus. This may be caused by a tumor or by an enlarged left atrium. Voice overuse or vocal cord neoplasms are other causes of hoarseness. Procedures involving general anesthesia necessitate the use of an endotracheal tube, which could potentially damage a vocal cord and cause hoarseness.
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