AAO-HNSF Updated Clinical Practice Guideline : Hoarseness (Dysphonia)

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


2. Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management.


3. 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.


4. 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 (SLP).


5. Clinicians should advocate for surgery as a therapeutic option for 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.


6. 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.


7. Clinicians should inform patients with dysphonia about control/preventive measures.\


8. Clinicians should document resolution, improvement or worsened symptoms of dysphonia, or change in QOL of patients with dysphonia after treatment or observation.


9. Clinicians should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy.

The guideline update group made a strong recommendation against following:

• Clinicians should not routinely prescribe antibiotics to treat dysphonia.


• Clinicians should not obtain the computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a primary voice complaint prior to visualization of the larynx.


• Clinicians should not prescribe antireflux 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.


• Clinicians should not routinely prescribe corticosteroids in patients with dysphonia prior to visualization of the larynx.

The policy level for the following recommendation about laryngoscopy at any time was an option: (1) Clinicians may perform diagnostic laryngoscopy at any time in a patient with dysphonia.