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• Rhinitis – Nasal discharge, with or without allergies, associated with sneezing, itching, and congestion.
• Psychogenic dysphonia – Look for comorbid psychological conditions.
• Spasmodic dysphonia – Usually has a strained / tight-sounding voice with breaks.
• Laryngeal malignancy – Risk factors include smoking and alcohol use disorder.
• Upper respiratory infection – Expect to see other symptoms such as cough, congestion, and fever that begin to resolve in a week.
• Chondronecrosis – Presents with hoarseness and breathiness, usually with a history of radiation exposure or trauma.
• Vocal fold cysts, polyps, nodules – Not always due to overuse or misuse; look for hoarseness and pitch changes, especially in those with occupations that require speaking.
• Laryngeal papillomatosis – Can cause airway obstruction and hoarseness in pediatric patients; typically presents as hoarseness in adults.
• Sulcus vocalis – Congenital or traumatic vocal cord defect that is the manifestation of loss of vocal cord pliability, usually with history of injury, surgery, or infection.
• Vocal cord paralysis – Immobility of vocal folds due to neurogenic injury from surgery, malignancy, or idiopathic causes that produces hoarseness, conversational dyspnea, and vocal fatigue, and sometimes airway obstruction with shortness of breath if bilateral.
• Epiglottitis – Thumbprint sign on lateral x-ray; have low threshold for intubation; check vaccinations.
• Postintubation trauma – Seen when large endotracheal tubes are used or in prolonged intensive care unit (ICU) intubations.
• Subglottic stenosis – History of trauma or intubation.
• Glottic stenosis – History of trauma or intubation.
• Croup – Predominately seen in children; check for steeple sign on chest x-ray, barking cough, and hoarseness.

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