The recurrent laryngeal nerve controls abduction and adduction of the vocal cords. Innervation of the laryngeal muscles is from the vagus nerve via its branches, the superior laryngeal and recurrent laryngeal nerves. Coughing requires adduction of the vocal cords to be effective. Resonance occurs in the pharynx, nose and mouth articulation uses the mouth and tongue.

Sound is produced in the larynx by vibration of the vocal cords. Type 2 diabetes (neuropathy, poor glycaemic control).Environment: poor acoustics, atmospheric irritants and low humidity.Professional voice use - eg, teachers, actors and singers.Smoking (also the main risk factor for laryngeal carcinoma).One study screening hoarseness in children aged 6-10 years reported a prevalence of 12.0% (7.8% of girls, 15.8% of boys). Treat the specific cause where feasible.Ī retrospective analysis of data from a large American claims database found that of almost 55 million individuals, 536,943 patients (ages 0 to >65 years) were given a dysphonia diagnosis (point prevalence rate of 0.98%).Emergency procedures such as tracheostomy may be needed.Do not examine the throat or attempt distressing procedures allow the patient to find the most comfortable position.Dyspnoea, stridor, wheeze, exertional dyspnoea, anxiety or signs of hypoxia.Possible signs of laryngeal obstruction are: Vocal cord immobility - laryngeal nerve palsy (depending on the position of the cords) or cricoarytenoid joint disease.Inflammation/oedema - airway burns, anaphylaxis, physical trauma, angio-oedema, hereditary angio-oedema.Infections - acute epiglottitis, diphtheria, croup, laryngeal abscess.Hoarseness may be a feature of laryngeal obstruction - so can be a warning of impending airway obstruction.

Hoarse voice causes