Clinical Practice Guideline



(Endorsed, 2010)

The following guideline on Hoarseness (Dysphonia) was developed by the American Academy of Otolaryngology and endorsed by the AAFP.

Summary of Recommendations

The panel made strong recommendations that:

  1. The clinician should not routinely prescribe antibiotics to treat hoarseness
  2. The clinician should advocate voice therapy for patients
    diagnosed with hoarseness that reduces voice-related QOL.

The panel made recommendations that:

  1. 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;
  2. 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;
  3. 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;
  4. 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;
  5. The clinician should not prescribe antireflux medications for patients with hoarseness without signs or
    symptoms of gastroesophageal reflux disease;
  6. The clinician should not routinely prescribe oral corticosteroids to treat hoarseness;
  7. The clinician should visualize the larynx before prescribing voice therapy and document/communicate the results to the speech-language pathologist; and
  8. 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.


These recommendations are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient's family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These recommendations are only one element in the complex process of improving the health of America. To be effective, the recommendations must be implemented.