Referral Guidelines Otolaryngology, Head and Neck Division

Hoarseness

Diagnosis/Definition

• The term "hoarseness" is used as a general description of a non-specific change in vocal intensity or quality.

Initial Diagnosis and Management

• History: Many times the etiology for a change in voice can be determined from a good history. Initially, the goal is to differentiate among traumatic, inflammatory, infectious, neurologic and neoplastic causes. Specific historical points should include the duration, persistence, and severity of the symptoms, recent neck or laryngeal trauma (e.g. general endotracheal anesthesia), associated URI symptoms, and alcohol/tobacco use. Also important is a thorough past medical history including connective tissue disorders, thyroid disorders, GERD, neurologic diseases, and psychiatric problems. Infections causing "hoarseness" will typically resolve over the course of 2 weeks. Many times an infection can worsen an existing inflammatory problem (e.g. GERD) causing persistent symptoms for greater than 2 weeks.
• Physical Examination: A thorough head and neck exam is indicated. Effort should be placed on identifying any evidence of infection and/or mass lesion in the pharynx or larynx. Presence of a neck mass typically signifies a malignancy.
• Ancillary Tests: If a traumatic etiology is suspected, a CT of the neck might be indicated to R/O a laryngeal fracture. In the acute setting the C-spine must be cleared.
• Initial Management: If there is a low suspicion for a neoplastic or traumatic etiology and/or there is a high likelihood of an infectious/inflammatory etiology, the following management strategy can be used:
• Voice rest
• Increased fluid intake
• Humidification of inhaled air
• Oral/inhaled steroid treatment and/or antibiotics when appropriate
• Treatment of GERD
• Treatment of SINUSITIS (See Sinusitis referral guidelines)
• Treatment for other underlying etiologies such as hypothyroidism, diabetes mellitus and rheumatoid disease should be undertaken.

Referral Guidelines