Hoarseness (Dysphonia)

Publication Date: March 1, 2018

Key Points

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)

Figure 1. Key Action Statement (KAS) Algorithm

Table 2. Definition of Common Terms

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Term Definition
Dysphonia Altered vocal quality, pitch, loudness, or vocal effort that impairs communication as assessed by a clinician and/or affects quality of life.
Hoarseness A symptom of altered voice quality reported by patients.
Worsened Voice-related Quality of Life (QOL) Self-perceived decrement in function; or a decline in economic status, as a result of voice-related dysfunction.
Dysarthria A speech disorder due to impaired movement of the structures used for speech production, including the lips, tongue, and complex musculature involved in articulation.
Dyspnea Difficult or labored breathing, shortness of breath.
Dysphagia Disordered or impaired swallowing.
Laryngoscopy Term used to describe visualization of larynx. Unless otherwise specified, its use in this guideline refers to indirect laryngoscopy (visualization of the larynx), which can be done by several methods including mirror examination, rigid rod-lens telescope examination, rigid rod-lens telescope, flexible fiber optic or flexible distal chip scopes. Each laryngoscopy technique has specific diagnostic indications.
Stroboscopy Advanced laryngeal imaging designed to visualize vocal fold vibratory abnormalities that cannot be appreciated using continuous light laryngoscopy. It uses a synchronized flashing light that passes through a laryngoscope.



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Patient Information

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