Hoarseness (Dysphonia)

- Executive summary

This guideline provides evidence-based recommendations on managing hoarseness (dysphonia) which affects nearly one-third of the population at some point in their lives. This guideline applies to all age groups evaluated in a setting where hoarseness would be identified or managed. It is intended for all clinicians who are likely to diagnose and manage patients with hoarseness.

·  The clinician should not routinely prescribe antibiotics to treat hoarseness.

·  The clinician should advocate voice therapy for patients diagnosed with hoarseness that reduces voice-related QOL.

·  The clinician should diagnose hoarseness (dysphonia) in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related QOL.

·  The clinician should assess the patient with hoarseness by history and/or physical examination for factors that modify management, such as one or more of the following: recent surgical procedures involving the neck or affecting the recurrent laryngeal nerve, recent endotracheal intubation, radiation treatment to the neck, a history of tobacco abuse, and occupation as a singer or vocal performer.

·  The clinician should visualize the patient’s larynx or refer the patient to a clinician who can visualize the larynx, when hoarseness fails to resolve by a maximum of three months after onset, or irrespective of duration if a serious underlying cause is suspected.

·  The clinician should not obtain computed tomography or magnetic resonance imaging of the patient with a primary complaint of hoarseness prior to visualizing the larynx.

·  The clinician should not prescribe anti reflux medications for patients with hoarseness without signs or symptoms of gastroesophageal reflux disease.

·  The clinician should not routinely prescribe oral corticosteroids to treat hoarseness.

·  The clinician should visualize the larynx before prescribing voice therapy and document/communicate the results to the speech-language pathologist.

·  The clinician should prescribe or refer the patient to a clinician who can prescribe, botulinum toxin injections for the treatment of hoarseness caused by adductor spasmodic dysphonia.

·  The clinician may perform laryngoscopy at any time in a patient with hoarseness or may refer the patient to a clinician who can visualize the larynx.

·  The clinician may educate/counsel patients with hoarseness about control/preventive measures.