Hoarseness

Hoarseness (Dysphonia)

(Affirmation of Value, July 2017)

The guideline, Hoarseness (Dysphonia), was updated by the American Academy of Otolaryngology-Head and Neck Surgery and categorized as Affirmation of Value by the American Academy of Family Physicians.

Key Recommendations

• Dysphonia (hoarseness) should be diagnosed in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life (QOL).
• Patients with hoarseness should be assessed by history and/or physical examination for underlying cause and factors that may modify management. Factors that may indicate the need for expedited laryngeal evaluation include: recent surgical procedures involving the neck or affecting the recurrent laryngeal nerve, recent endotracheal intubation, presence of concomitant neck mass, respiratory distress or stridor, radiation treatment to the neck, a history of tobacco abuse, and occupation as a singer or vocal performer.
• The patient’s larynx should be visualized when dysphonia fails to resolve or improve within 4 weeks or if a serious underlying cause is suspected.
• Computed tomography or magnetic resonance imaging should not be obtained in patients with a primary complaint of dysphonia prior to visualizing the larynx.
• Anti-reflux medications or corticosteroids should not be prescribed for patients with isolated dysphonia without prior visualization of the larynx.
• Antibiotics should not be routinely prescribed to treat dysphonia.
• Following diagnostic laryngoscopy:
  • Voice therapy should be recommended for patients who have dysphonia from a cause amenable to voice therapy.
  • Surgery should be considered for patients with suspected: 1) laryngeal malignancy, 2) benign laryngeal soft tissue lesions, 3) glottic insufficiency.
  • Botulinum toxin injections should be considered for treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia.

See Full Recommendation for further details.