Hoarseness Diagnosis and Treatment Addressed in New Guidelines


The next time you shout until hoarseness sets in during your child’s softball or soccer game, you can rest assured that there are now guidelines to help healthcare practitioners effectively treat your condition. For the first time, physicians have at their disposal a recommended plan of action for diagnosis, treatment, and education of patients regarding hoarseness, offered by the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNS).

The guidelines were created by a panel of experts from various fields, including neurology, speech-language pathology, family medicine, geriatric medicine, internal medicine, otolaryngology-head and neck surgery, pediatrics, nursing, and healthcare consumers. The work is entitled “Clinical Practice Guideline on Hoarseness” and is scheduled to appear in the September 2009 issue of Otolaryngology—Head and Neck Surgery.

Also known as dysphonia, hoarseness affects approximately 20 million people in the United States at any given time. Hoarseness is a condition in which a person’s vocal quality, loudness, pitch, and effort required to vocalize are altered to the extent that it negatively impacts communication. It is caused by irritation or damage to the vocal cords, resulting in a voice that can be raspy and harsh sounding. People of any age can experience hoarseness, and the condition can result in lost work, depression, social isolation, and poorer quality of life.


Hoarseness can be caused by behaviors such as yelling at sporting events, excessive singing, smoking, or crying. Other causes of hoarseness include thyroid conditions, upper respiratory tract infections, vocal cord nodules or polyps, gastroesophageal reflux disease, allergies, cancer of the larynx, and neurological conditions such as Parkinson’s disease and stroke.

The new guidelines are intended to enhance the diagnosis of hoarseness, promote appropriate treatment, improve treatment outcomes, and help educate patients about hoarseness and how to prevent it. According to a survey conducted by the AAO-HNS, nearly 50 percent of adults are not aware that persistent hoarseness may be a symptom of cancer. Other research reveals that less than 6 percent of people who experience hoarseness seek treatment.

Some key elements of the new guidelines include having clinicians consider the possibility that a serious condition or medication is causing the hoarseness; use of laryngoscopy for persistent hoarseness or if the cause is uncertain; avoidance of imaging studies for a primary complaint of hoarseness before visualizing the larynx; specific recommendations on when and when not to prescribe anti-reflux medications, steroids, and antibiotics; consideration of voice therapy; and discussion of ways to reduce the risk of hoarseness.

The authors of the guidelines hope that they provide healthcare practitioners with effective tools to help improve the quality of treatment and outcomes for hoarseness and reduce healthcare costs.

Science Daily Sept. 2, 2009