Dysphonia (Hoarseness): AAO-HNSF Releases Updated Clinical Guideline for Treatment
Am Fam Physician. 2018 Nov 15;98(10):606-607.
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Key Points for Practice
• Dysphonia can be diagnosed in patients with altered voice quality, pitch, loudness, or vocal effort that impairs quality of life.
• Laryngoscopy should be performed if dysphonia does not resolve within four weeks or if a serious underlying condition is suspected.
• Antireflux medications should not be used in the absence of symptoms of gastroesophageal reflux disease or laryngopharyngeal reflux.
From the AFP Editors
Dysphonia is a condition that is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs quality of life. Technically, dysphonia is a change in voice production detected on clinical examination, whereas hoarseness is the symptom reported by the patient. About one-third of the population will be affected by dysphonia during their lifetime. Several billion dollars in lost productivity from work absenteeism and frequent clinic visits are attributed to dysphonia annually. To improve the quality of care for patients of all ages with dysphonia, the American Academy of Otolaryngology–Head and Neck Surgery Foundation (AAO-HNSF) updated guidelines to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm.
IDENTIFICATION OF ABNORMAL VOICE
Based on observational studies, it is recommended that physicians diagnose dysphonia in patients with altered voice quality, pitch, loudness, or vocal effort that impairs quality of life. An assessment of voice quality and information from caregivers should be relied on rather than clinical tests. Hoarseness reported by the patient or caregiver should be considered a symptom of altered voice quality. Note that patients often discount dysphonia symptoms, which can lead to a delay in seeking treatment. Raising awareness of dysphonia and its effects on quality of life, or as a sign of a more serious underlying condition, could encourage patients to seek medical treatment earlier.
IDENTIFYING UNDERLYING CAUSES
Based on observational studies, it is recommended that physicians perform a history and physical examination to determine the underlying causes of dysphonia. The examination also helps the physician determine
Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.
This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.
A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.
Copyright © 2018 by the American Academy of Family Physicians.
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