Hoarseness (Dysphonia)

Publication Date: March 1, 2018
Last Updated: December 16, 2022

Key Points

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


Identification of Abnormal Voice

Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces QOL. ( C , R )

Identifying Underlying Cause of Dysphonia

Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. ( C , R )

Escalation of Care

Clinicians should assess the patient with dysphonia by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include but are not limited to: recent surgical procedures involving the head, neck or chest, recent endotracheal intubation, presence of concomitant neck mass, respiratory distress or stridor, history of tobacco abuse, and whether he/she is a professional voice user. ( B , S )

Laryngoscopy and Dysphonia

Clinicians may perform diagnostic laryngoscopy at any time in a patient with dysphonia. ( C , O )

Need for Laryngoscopy in Persistent Dysphonia

Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within 4 weeks, or irrespective of duration if a serious underlying cause is suspected. ( C , R )


Clinicians should NOT obtain computed tomography (CT) or magnetic resonance imaging (MRI) in patients with a primary voice complaint prior to visualization of the larynx. ( C , R )


Anti-Reflux Medication and Dysphonia
Clinicians should NOT prescribe anti-reflux medications to treat isolated dysphonia, based on symptoms alone attributed to suspected gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR), without visualization of the larynx. ( B , R )
Corticosteroid Therapy
Clinicians should NOT routinely prescribe corticosteroids in patients with dysphonia prior to visualization of the larynx. ( B , R )
Antimicrobial Therapy
Clinicians should NOT routinely prescribe antibiotics to treat dysphonia. ( A , S )
Laryngoscopy Prior to Voice Therapy
Clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy and document/communicate the results to the speech-language pathologist. ( C , R )
Advocating for Voice Therapy
Clinicians should advocate voice therapy in patients with dysphonia from a cause amenable to voice therapy. ( A , S )
Clinicians should advocate for surgery as a therapeutic option in patients with dysphonia with conditions amenable to surgical intervention such as suspected malignancy, symptomatic benign vocal fold lesions that do not respond to conservative management, or glottic insufficiency. ( B , R )
Botulinum Toxin
Clinicians should offer, or refer to a clinician who can offer, botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia. ( B , R )
Education/ Prevention
Clinicians should inform patients with dysphonia about control/preventive measures. ( C , R )
Clinicians should document resolution, improvement or worsened symptoms of dysphonia, or change in quality of life in patients with dysphonia after treatment or observation. (C, R)

Recommendation Grading



Hoarseness (Dysphonia)

Authoring Organization

Endorsing Organizations

Publication Month/Year

March 1, 2018

Last Updated Month/Year

March 19, 2024

Document Type


External Publication Status


Country of Publication


Document Objectives

The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence.

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


Diagnosis, Treatment, Management, Prevention

Diseases/Conditions (MeSH)

D006685 - Hoarseness, D055154 - Dysphonia, D007827 - Laryngitis


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


Number of Source Documents
Literature Search Start Date
December 1, 2015
Literature Search End Date
April 1, 2016