Key Points

Document Overview

Design and created by Guideline Central in participation with the American Academy of Otolaryngology - Head and Neck Surgery Foundation.

Hoarseness (Dysphonia)

American Academy of Otolaryngology - Head and Neck Surgery Foundation

Publication Date: Mar 1, 2018

Page Last Updated: May 5, 2026

Evidence Quality and Recommendation Grades

Evidence Quality and Recommendation Grades^a
Evidence Quality			Recommendation
Treatment and Harm	Diagnosis	Strength
A	High-quality RCTs	Systematic review of consistent cross-sectional studies	S	Strong recommendation
B	Consistent RCTs	Consistent individual cross-sectional studies	R	Recommendation
C	Observational studies	Nonconsecutive studies, case-control studies, or other studies of poor quality	O	Option
D	Case reports, consensus opinions		N	None
X	Exceptional situations with clear benefit		X

^a See full text guidelines for details.

Document Overview

Document Title: Hoarseness (Dysphonia)

Authoring Society: American Academy of Otolaryngology - Head and Neck Surgery Foundation

Endorsing Societies

American Academy of Otolaryngic Allergy

American Academy of Pediatrics

American Academy of Physical Medicine and Rehabilitation

American College of Chest Physicians

Society of Otorhinolaryngology and Head-Neck Nurses

American Speech-Language-Hearing Association

Document Publication Date: Mar 1, 2018

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/0194599817751030

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: This guideline provides evidence-based recommendations on treating patients who present with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia.

Scope: Diagnosis, Management, Prevention, Treatment

Diseases/Conditions (MeSH)

D006685 - Hoarseness

D055154 - Dysphonia

D007827 - Laryngitis

D006685 - Hoarseness

D055154 - Dysphonia

D007827 - Laryngitis

Keywords: dysphonia, hoarseness, laryngitis, voice, voice change, voice disorders, voice disturbance

Target Patient Population: all individuals presenting with dysphonia, regardless of age

Target Provider Population: all clinicians who diagnose and treat patients with dysphonia

Inclusion Criteria: Male, Female, Adolescent, Adult, Child, Infant, Older Adult

Health Care Settings: Ambulatory, Childcare Center, Long Term Care, Outpatient, School

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant, Speech-Language Pathologist

Recommendation Development Processes & Methodology

Number of Source Documents: 470

Literature Search Start Date: Tuesday, December 1, 2015

Literature Search End Date: Friday, April 1, 2016

Includes peer/external review process?: Yes

Includes public comment process?: Yes

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: Yes

Hoarseness (Dysphonia)

Key Points

Table 1. Summary of Guideline Key Action Statements (KAS)

Diagnosis

Identification of Abnormal Voice

Identifying Underlying Cause of Dysphonia

Escalation of Care

Laryngoscopy and Dysphonia

Need for Laryngoscopy in Persistent Dysphonia

Imaging

Treatment

Anti-Reflux Medication and Dysphonia

Corticosteroid Therapy

Antimicrobial Therapy

Laryngoscopy Prior to Voice Therapy

Advocating for Voice Therapy

Surgery

Botulinum Toxin

Education/ Prevention

Outcomes

Evidence Quality and Recommendation Grades

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology