Hoarseness

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Read the guidelines for AAFP endorsements.

AAFP Endorsed Recommendations

Endorsement of the Clinical Practice Guideline for Hoarseness

The panel made strong recommendations that:

  1. The clinician should not routinely prescribe antibiotics to treat hoarseness
    and
  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.

AAO-HNS Clinical Practice Guideline: Hoarseness -- (Endorsed June 2010)