The American Academy of Otolaryngology–Head and Neck Surgery has released updated guidelines on dysphonia management. The guidelines include recommendations for escalation of care, the need for laryngoscopy for persistent hoarseness, and treatment.
Key recommendations in the updated guideline include:
- Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life.
- Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management.
- 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 the patient is a professional voice user.
- Clinicians may perform diagnostic laryngoscopy at any time for a patient with dysphonia.
Clinicians should perform laryngoscopy, or refer to a clinician who can perform laryngoscopy, when dysphonia fails to resolve or improve within four weeks. - Clinicians should not obtain CT or MRI among patients with a primary voice complaint prior to visualization of the larynx.
Clinicians should not prescribe anti-reflux medications to treat isolated dysphonia, based on symptoms alone attributed to suspected GERD or LPR without visualization of the larynx. - Clinicians should perform diagnostic laryngoscopy before prescribing voice therapy.
- 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.
- Clinicians should offer botulinum toxin injections for the treatment of dysphonia caused by spasmodic dysphonia and other types of laryngeal dystonia.
- Clinicians should document resolution, improvement, or worsened symptoms of dysphonia or change in QOL among patients with dysphonia after treatment or observation.