Evaluation of hoarseness and dysphonia

Dysphonia, also known as hoarseness, is a general term used to describe a variety of changes in voice quality. Individuals with hoarseness or voice changes that fail to resolve or improve within a 4 week period should be referred for evaluation and visualization of the larynx.[1]Ferraro EL, Nelson RC, Bryson PC. Hoarseness: when to observe and when to refer. Cleve Clin J Med. 2023 Aug 1;90(8):475-81. https://www.ccjm.org/content/90/8/475.long http://www.ncbi.nlm.nih.gov/pubmed/37527869?tool=bestpractice.com [2]Francis DO, Smith LJ. Hoarseness guidelines redux: toward improved treatment of patients with dysphonia. Otolaryngol Clin North Am. 2019 Aug;52(4):597-605. http://www.ncbi.nlm.nih.gov/pubmed/31101359?tool=bestpractice.com ​

Hoarseness is not normal in adults or children, and may be an indication of a serious underlying pathology. Evaluation should take place as early as possible whenever serious underlying cause is suspected, irrespective of timeframe.[3]Stachler RJ, Francis DO, Schwartz SR, et al. Clinical practice guideline: hoarseness (dysphonia) (update). Otolaryngol Head Neck Surg. 2018 Mar;158(1 Suppl):S1-42. https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/0194599817751030 http://www.ncbi.nlm.nih.gov/pubmed/29494321?tool=bestpractice.com

A wide variety of laryngeal and extralaryngeal conditions can cause hoarseness, and there are many challenges associated with its evaluation. Early identification of symptoms, by both the patient and physician, and visualization of the larynx are mandatory for diagnosis. However, confusion surrounding the terminology of the various laryngeal lesions and inadequate laryngeal visualization contribute to the difficulty in diagnosing hoarseness. Diagnosis and treatment are frequently delayed as a result of misdiagnosis or poor awareness of early voice changes.

Management of voice disorders requires specialized knowledge and a multidisciplinary team approach.