Clinical Practice Guideline: Hoarseness (Dysphonia) (Update)
Otolaryngology—Head and Neck Surgery
Stachler, R. J., Francis, D. O., et al. (2018).
Otolaryngology—Head and Neck Surgery, 158(1_Suppl), S1-S42.
This is an update of the guideline published by the American Academy of Otolaryngology—Head and Neck Surgery in 2009. It provides recommendations pertaining to management of dysphonia in all populations. Treatment and diagnostic modifications are inconsistently provided for key populations such as "prior laryngeal surgery, recent surgical procedures involving the neck or affecting the recurrent laryngeal nerve, recent endotracheal intubation, history of radiation treatment to the neck, direct laryngeal trauma, craniofacial abnormalities, velopharyngeal insufficiency, and dysarthria" (p. S3).
American Academy of Otolaryngology—Head and Neck Surgery Foundation
<div>"Clinicians should advocate for voice therapy for patients with dysphonia from a cause amenable to voice therapy" (Strong Recommendation; p. S21).</div>
<div>Before voice treatment is prescribed, "clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy" (p. S20). Results should be documented and/or communicated to the speech-language pathologist (Recommendation).</div>
<div>"Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces [quality of life] QOL" (Recommendation; p. S7). During assessment of an individual with dysphonia, the clinician "should assess ... by history and physical examination for underlying causes of dysphonia and factors that modify management" (Recommendation; p. S9).</div>
<div>During assessment, clinicians should consider that some individuals with dysphonia will require prompt laryngoscopy and/or referral to a specialist with laryngoscopy. "Clinicians should assess ... by history and physical examination to identify factors where expedited laryngeal evaluation is indicated. These include but are not limited to</div>
<ul>
<li>recent surgical procedures involving the head, neck or chest;</li>
<li>recent endotracheal intubation;</li>
<li>presence of concomitant neck mass;</li>
<li>respiratory distress or stridor; </li>
<li>history of tobacco abuse; and</li>
<li>whether the patient is a professional voice user" (Strong Recommendation; p. S12). </li>
</ul>
<div>Diagnostic laryngoscopy may be performed at any time by the clinician for a patient with dysphonia (Option); however, "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" (Recommendation; p. S15).</div>
<div>"Clinicians should inform patients with dysphonia about control/preventive measures" (Recommendation; p. S24).</div>
<div>"Clinicians should document resolution, improvement, or worsened symptoms of dysphonia or change in [quality of life] QOL among patients with dysphonia after treatment or observation" (Recommendation; p. S25).</div>
