Hoarseness - Sasei (English spelling)

Japanese: 嗄声 - させい（英語表記）Hoarseness

What are the symptoms?

The voice flows from the lungs. Exhalation ( Stroke ) A good voice is produced when the vocal cords are in good condition and the subglottal pressure, expiratory air flow, and glottal resistance are all in a constant state.

Hoarseness, or "raspy voice," is a comprehensive abnormality in the tone of the voice, and can be described as a state in which the vibration of the vocal cords is disturbed. The main diseases that actually cause hoarseness are organic lesions of the vocal cords (Figure 8) and motor paralysis, but functional disorders are also possible.

Testing and diagnosis

The pathology of voice disorders can be considered to be disorders in the four elements of voice: ① pitch, ② loudness, ③ duration, and ④ timbre. Therefore, a single method is insufficient for the evaluation of hoarseness, and it is necessary to evaluate it using various scales.

The degree of the disorder can be easily evaluated by the auditory impression of the voice or by measuring the maximum duration of the voice. There are also tests using special equipment, such as acoustic analysis and speech function tests.

To confirm organic lesions, laryngeal fiberscopes and laryngeal Rigid endoscope ( Production ) In addition, vocal cord vibration can be understood to some extent by laryngeal stroboscopy.

Treatment methods

1. Conservative treatment

Drug treatment

Hoarseness is often caused by acute or chronic laryngitis. Anti-inflammatory drugs and local inhalation therapy (nebulizer therapy, inhaled steroids) are the main treatments for inflammation. In cases of severe edema, systemic administration of steroids may be required.

●Voice training

In cases of functional dysphonia, the condition may be improved by teaching vocal techniques through voice training. In cases of hypertonic phonation, relaxation techniques are used, and in cases of incomplete glottal closure, pushing techniques are used.

Vocal hygiene

Basic guidance items such as vocal rest, proper vocal technique, smoking cessation, and lifestyle changes are called "vocal hygiene." It is especially important to maintain vocal hygiene for voice disorders caused by vocal overuse.

2. Surgical treatment

The surgical methods include endoscopic surgery under local anesthesia and microlaryngoscopy under general anesthesia. Direct Mirror ( Choktatsukiyo ) Treatment options include laryngeal microsurgery (Figure 9) and laryngeal framework surgery, which involves manipulating the laryngeal cartilage through an external incision. Here we will introduce the treatment methods for each disease.

Benign tumor lesions

Vocal cord polyp (Figure 8, a), vocal cord nodule (Figure 8, b), polypoid vocal cord (Figure 8, c), vocal cord Cyst ( News ) In such cases, it is possible to improve the vibration state of the vocal cords by removing the lesion. This is usually done by microlaryngoscopy, but in some cases, endoscopic surgery under local anesthesia can be performed on an outpatient basis.

Tumor lesions

Laryngeal papilloma (Fig. 8 d), larynx Leukoplakia ( White banner ) Tumor lesions such as bronchial cancer (same source, e) and laryngeal cancer (same source, f) require early detection, diagnosis, and treatment.

It is often difficult to distinguish based on laryngeal findings alone, so a tissue biopsy is performed endoscopically or via microlaryngoscopy to make a pathological diagnosis.

In treatment, complete removal of the lesion takes priority over improving the voice disorder.

●Vocal cord paralysis (recurrent laryngeal nerve paralysis)

Controls the internal muscles of the larynx Recurrent laryngeal nerve ( Conflict investigation ) of paralysis ( Paralysis ) is due to vocal cord mobility disorder and vocal cord atrophy ( Ishku ) In cases where recovery is not possible, thyroplasty type 1, a laryngeal framework surgery, is performed to correct the position of the vocal cords. Arytenoid ( Fins ) Chondrocartilage adduction surgery is performed, and for atrophy, intravocal cord injection surgery is performed.

Spasmodic dysphonia

Injecting botulinum toxin to paralyze the laryngeal muscles is effective, but the effect is temporary, lasting 3 to 6 months, and repeated treatments are required. In addition, it is difficult to obtain the drug in Japan, and treatment is only available at a limited number of facilities.

Recently, attempts have been made to perform microlaryngeal surgery, such as intrinsic muscle resection and thyroplasty.

Atrophic lesions

For atrophied vocal cords, intracordal injection ( Filling technique ( 100% ) ) is used. Filling materials include collagen, autologous (your own) fat, and autologous fascia.

It is effective for vocal muscle atrophy caused by recurrent laryngeal nerve paralysis, Sulcus vocalis ( The National Diet Library ) In cases where the submucosal tissue in the vibrating area is lost, such as in the above cases, it becomes difficult to improve the voice.

Jiro Tayama

Figure 8 Organic lesions causing hoarseness
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Figure 8 Organic lesions causing hoarseness

Figure 9 Microscopic direct laryngeal surgery
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Figure 9 Microscopic direct laryngeal surgery

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな症状か

　声は、肺から流れ出る「呼気(こき)」によって声帯が振動することで生じる複合音です。よい声は、声帯が良好な状態にあって、かつ発声時の声門下よりの圧力・呼気の流量・声門抵抗が一定の状況にある時につくられます。

　嗄声、すなわち「かすれ声」は、音色に関する総合的な声の異常であり、声帯の振動が乱れた状態ともいえます。実際に嗄声を来す疾患としては、声帯の器質的病変（図8）や運動麻痺が主体ですが、機能的な障害も考えられます。

検査と診断

　音声障害の病態としては、音声の①高さ、②大きさ、③長さ、④音色の4つの要素での障害が考えられます。したがって嗄声の評価は単一の方法では不十分であり、さまざまな尺度で評価する必要があります。

　声の聴覚的印象からその程度を評価する方法や、音声の最大持続時間の測定は、簡便にできる方法です。音響分析や発声機能検査など、特殊な装置を用いて行う検査もあります。

　器質的病変を確認するためには、喉頭ファイバースコープや喉頭硬性側視鏡(こうせいそくしきょう)による内視鏡検査が必要になります。また、喉頭ストロボスコピーによって、声帯振動がある程度把握できます。

治療の方法

①保存的治療

●薬物治療

　嗄声の多くは、急性喉頭炎や慢性喉頭炎などが原因になります。消炎薬や局所吸入治療（ネブライザー療法、吸入ステロイド薬）による消炎が主体になります。浮腫が高度な場合には、ステロイド薬の全身投与が行われることもあります。

●音声訓練

　機能性発声障害などでは、音声訓練による発声法の指導で改善する場合もあります。過緊張発声ではリラクゼーション法、声門閉鎖不全型の発声ではプッシング法などを用います。

●声の衛生

　声の安静、適切な発声方法、禁煙、生活習慣の改善などは、基本的な指導項目で、「声の衛生」と呼ばれます。とくに声の酷使による音声障害に対しては、声の衛生を十分守ることが重要になります。

②外科的治療

　手術方法としては、局所麻酔による内視鏡手術、全身麻酔による顕微鏡下喉頭直達鏡(ちょくたつきょう)手術（喉頭微細手術）（図9）、外切開により喉頭の軟骨を操作する喉頭枠組み手術などが行われますが、ここでは疾患別に治療法を紹介します。

●良性腫瘤性(しゅりゅうせい)病変

　声帯ポリープ（図8のa）、声帯結節（同、b）、ポリープ様声帯（同、c）、声帯嚢胞(のうほう)などは、切除により声帯の振動状態を改善することが可能です。通常は喉頭微細手術で切除しますが、症例によっては外来通院による局所麻酔下内視鏡手術が可能です。

●腫瘍性病変

　喉頭乳頭腫(にゅうとうしゅ)（図8のd）、喉頭白板症(はくばんしょう)（同、e）、喉頭がん（同、f）などの腫瘍性病変は、早期発見・診断および治療が必要になります。

　喉頭所見のみでは判別が困難な場合も多く、病理診断のために、内視鏡下もしくは喉頭微細手術での組織生検が行われます。

　治療においては、音声障害の改善よりも病変の完全除去が優先になります。

●声帯麻痺（反回神経麻痺）

　喉頭の内部の筋群を支配する反回神経(はんかいしんけい)の麻痺(まひ)は、声帯の可動性障害と声帯の萎縮(いしゅく)により、音声障害を引き起こします。回復不能例に対しては、声帯の位置を補正するために喉頭枠組み手術である甲状軟骨形成術1型や披裂(ひれつ)軟骨内転術が、萎縮に対しては声帯内注入術などが行われます。