Aetiological factors of hoarseness in patients attending at Kathmandu University Hospital

Objective: To evaluate the aetiological factors of hoarseness. Methods: This is a prospective, nonrandomized and longitudinal study conducted from 1 august 2011 to 1 august 2012 in department of otorhinolaryngology of Kathmandu university Hospital, Dhulikhel, Nepal. All the patients with history of hoarseness underwent clinical examination, routine as well as special investigation to find the diagnosis. The final results were analyzed by simple manual analysis with frequency and percentage using Microsoft Excel software 2007. Results: There were total 280 patients included in the study. Among them the age groups of 21 – 30 years and 31 – 40 years were mainly suffer from hoarseness. Similarly, among 280 patients 200 (71.45%) were males whereas 80 (28.6%) were females with male to female ratio of 2.5:1.. The most common cause as per the distribution was acid peptic laryngitis with frequency of 37.8% whereas tuberculosis of larynx, papillary carcinoma of thyroid and papilloma of vocal cord accounts for only 0.4% each. Conclusion: There was etiological variation in hoarseness ranging from simple laryngitis to malignancies. So it is important not to ignore the hoarseness and precise history, examination and investigations should be done.


Introduction
Hoarseness is one of the common symptoms encountered by otorhinolaryngologists in their practice.It is the term uses to describe a As per said by Chevalier Jackson "Hoarseness is a symptom of utmost significance and should be reacted promptly as the frequency of its occurrence as a distant signal of malignancy and other conditions" The main aim of our study is to evaluate the frequency and aetiological factors of hoarseness.

Methods
This is a prospective, non-randomized and longitudinal study conducted from 1 st August 2011 to 1 st August 2012 in the department of otorhinolaryngology of Kathmandu university Hospital, Dhulikhel, Nepal.All the patients who presented with history of hoarseness were included in the study.The detailed history, clinical examination, routine as well as special investigation (flexible nasopharyngolaryngoscopy and direct laryngoscopy) was performed to find the diagnosis.The final results were analyzed by SPSS 11.5 software.

Result
There were total 280 patients included in the study.Among them the age groups of 21 -30 years and 31 -40 years were mainly suffer from hoarseness as shown in table-I.In our study, the male: female ratio was 2.5:1, like that of study performed by Kumar H et al 10 , Baitha S et al, 9 Saeed M and Mian FA 11 and Banjara H et al 13 but in contrast with study done by Brodnitz FS 14 which showed almost equal number of male to female ratio.Such a huge difference between male and female in our study could be because of male dominated society and they involved in smoking, alcoholism, exposure to pollutant and voice abuse whereas female from rural areas are unaware of their health problem.
In the present study, the frequency of acid peptic laryngitis was 37.8% which contrast with the study performed by Baitha S et al 9 which showed only 1.81%.Such higher frequency in our study could be because most of our patients suffer from gastro-esophageal reflux disease.
Likewise, the frequency of acute laryngitis was 34.6% in our study which is comparable to study performed by Baith S et al 9 and Khan FA et al 12 but contrast with the study performed by Kumar H et al 10 .
In our study, the frequency of laryngeal tuberculosis was only 0.4% which was much lower than the study performed by Kumar H et al 10 , Saeed M and Mian FA 11 and Iqbal K et al 16 .The reason could be because of more prevalence but early diagnosis and treatment of pulmonary tuberculosis in our region.
The neoplastic and neurological cause reported to be 5.8% and 2.1% in our study.
The frequencies were lower than other different studies 9,12,17 .
In our study, the frequency of intubation granuloma was 0.7%.The results were comparable to study performed by Baitha S et al 9 but very lower than the other studies 11,18- 21 .The lower frequency in our study could be timely elective tracheostomy of needy patients.
The hypothyroidism was 1.4% in our study like that of Saeed M and Mian FA 11 but differ from Ahmed B et al 22 which showed 83.3%.It could be in our place the prevalence of hypothyroidism is not so high.

Conclusion
There was variation in etiologies in hoarseness ranging from simple laryngitis to malignancies.So it is important not to ignore the hoarseness and precise history, examination and investigations should be done.

Table-I Age distribution of patients (n=280)
were males whereas 80 (28.6%) were females with male to female ratio of 2.5: 1 as shown in

table 2 .
The table3showed the distribution of hoarseness as per etiology.Among them, the most common cause was acid peptic laryngitis with frequency of 37.8% whereas tuberculosis of larynx, papillary carcinoma of thyroid and papilloma of vocal cord accounts for only 0.4% each.