Voice problems and sore throat are two of the most common complaints associated with the throat, larynx and hypopharynx regions. Voice disorders should be distinguished in problems with the articulation of the voice, or dysarthria, and hoarseness, or dysphonia, when there is a change in the quality of the voice instead.

Hoarseness is the most frequent among the two. It is important to determine if hoarseness has been of a gradual onset or sudden onset. Gradual onset may be as a result of smoking or drinking alcohol, whilst sudden onset may be as a result of an infection or vocal abuse. Smoking and alcohol should be documented in all cases. A patient’s occupation may provide vital information to the history, especially if they use their voice in a professional way such as a singer. In these cases it is worth asking the patient if they have experienced a change in their pitch or abnormal pitch range. The clinician should determine if their hoarseness is constant, or whether it changes throughout the day. Any exposure to chemicals or corrosive substances may also be important. Previous trauma, surgery or endotracheal intubation should be ascertained. Patients may describe their voice disturbances as breathy, hoarse, low-pitched, strained, and trembling or a feeling of vocal fatigue. Clinicians should be aware that specific voice disturbances could help the focus on a differential diagnosis. For example, breathy complaints could indicate functional dysphonia, vocal cord paralysis or abductor spasmodic dysphonia.

Dysarthria results from a neurological injury of the phonation system. As such, the causes may be several, including multiple sclerosis, Parkinson’s disease, Parkinson plus syndromes, stroke, motor neuron disease and others. A sore throat itself is actually a symptom. Other common presenting symptoms include a feeling of a lump in throat, mucus in the throat and general discomfort. Sore throat is usually caused by viral infection; however, the most common bacterial infection affecting the throat is Group A beta-haemolytic streptococcus. The clinician should ascertain the duration and severity of the symptoms, any dysphagia, rash or stridor, whether the patient feels systemically unwell and whether there is the presence of trismus. Associated symptoms may include malaise, headache, rhinitis, cough and hoarseness. These symptoms are often benign in nature. However, can also be symptoms of malignancy. Patients with acid reflux may present with throat problems. If this is linked with symptoms of dyspepsia or gastro-oesophageal reflux it should be investigated (Fig. 4.1).

Tongue depressors, (Fig. 4.2) typically a disposable wooden spatula, are used to depress the tongue to allow the clinician to inspect the patient’s mouth and throat structures. Again an otoscope can be used as a torch to improve visualisation of the mouth and throat. A clinician should always wear gloves when performing an oral examination.

It is a frequent symptom and often associated with viral upper respiratory tract infection.