Clinical Practice Guideline
(Affirmation of Value, July 2017)
The guideline, Hoarseness (Dysphonia), was updated by the American Academy of Otolaryngology-Head and Neck Surgery and categorized as Affirmation of Value by the American Academy of Family Physicians.
Dysphonia (hoarseness) 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 underlying cause and factors that may modify management. Factors that may indicate the need for expedited laryngeal evaluation include: recent surgical procedures involving the neck or affecting the recurrent laryngeal nerve, recent endotracheal intubation, presence of concomitant neck mass, respiratory distress or stridor, 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 dysphonia fails to resolve or improve within 4 weeks or if a serious underlying cause is suspected.
Computed tomography or magnetic resonance imaging should not be obtained in patients with a primary complaint of dysphonia prior to visualizing the larynx.
Anti-reflux medications or corticosteroids should not be prescribed for patients with isolated dysphonia without prior visualization of the larynx.
- Antibiotics should not be routinely prescribed to treat dysphonia.
Following diagnostic laryngoscopy:
- Voice therapy should be recommended for patients who have dysphonia from a cause amenable to voice therapy.
- Surgery should be considered for patients with suspected: 1) laryngeal malignancy, 2) benign laryngeal soft tissue lesions, 3) glottic insufficiency.
- Botulinum toxin injections should be considered for treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia.
See Full Recommendation for further details.
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.