Laryngology and Voice
Core concepts
Understand voice production as a three-part system: power (respiratory), source (vocal folds), filter (resonance/articulation). Know benign vocal fold lesions: nodules (bilateral, phonotrauma), polyps (often unilateral, haemorrhagic), Reinke's oedema (smoking), cysts, and granuloma (post-intubation/reflux). Distinguish muscle tension dysphonia (functional, responds to voice therapy) from structural disease. Recognise spasmodic dysphonia (adductor: strained, strangled; abductor: breathy) and vocal fold paralysis (unilateral: breathy, weak; bilateral: stridor - emergency). Know laryngopharyngeal reflux as a cause of chronic throat clearing and posterior laryngitis.
Traps
Persistent hoarseness >3 weeks in an adult requires laryngoscopy to exclude malignancy - do not treat empirically as laryngitis. Bilateral vocal fold immobility is an airway emergency, not a voice problem. Stridor is inspiratory; expiratory noise suggests lower airway. Beware assuming all dysphonia is reflux.
Rule of thumb
For any hoarseness lasting >3 weeks, visualise the larynx. For bilateral vocal fold paralysis with stridor, secure the airway first and defer elective voice surgery.