Clinical Practice Guideline


Hoarseness (Dysphonia)

(Reaffirmed, May 2016)

The guideline, Hoarseness (Dysphonia), was developed by the American Academy of Otolaryngology—Head and Neck Surgery and was endorsed by the American Academy of Family Physicians.

Key Recommendations

  • Hoarseness (dysphonia) 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 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 patient's larynx should be visualized when hoarseness fails to resolve by a maximum of three months after onset or if a serious underlying cause is suspected.
  • Computed tomography or magnetic resonance imaging should not be obtained with a primary complaint of hoarseness prior to visualizing the larynx.
  • Anti-reflux medications should not be prescribed for patients with hoarseness without signs or symptoms of gastroesophageal reflux disease.
  • Oral corticosteroids should not be routinely prescribed to treat hoarseness.
  • Antibiotics should not be routinely prescribed to treat hoarseness.
  • Surgery should be considered for patients with suspected: 1) laryngeal malignancy, 2) benign laryngeal soft tissue lesions, 3) glottic insufficiency.

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.