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Clinical Practice Guideline: Hoarseness (Dysphonia)

Clinical Practice Guideline: Hoarseness (Dysphonia)


The original guideline was published as a supplement in the September 2009 issue of Otolaryngology–Head and Neck Surgery and is currently undergoing an update.

Timeline: Public Comment January 2017 (tentative) - Publication March 2018 (tentative)

Update Leadership: Robert J. Stachler, MD (Chair), David O. Francis, MD, MS (Assistant Chair), Seth R. Schwartz, MD, MPH (Methodologist)

Guideline Update Group: Cecelia C. Damask, DO, German Paul Digoy, MD, Evelyn C. Granieri, MD, MPH, MSEd, Helene J. Krouse, PhD, RN, ANP-BC, CORLN, Scott J. McCoy, DMA, Daniel R. Ouellette, MD, Rita R. Patel, PhD, CCC-SLP, Charles W. Reavis, Libby Jo. Smith, DO, Marshall Smith, MD, Steven W. Strode, MD, MEd, MPH, Peak Woo, MD

The information below is from the original publication. 

The primary purpose of this guideline is to improve diagnostic accuracy for hoarseness (dysphonia), reduce inappropriate antibiotic use, reduce inappropriate steroid use, reduce inappropriate use of anti-reflux medications, reduce inappropriate use of radio-graphic imaging, and promote appropriate use of laryngoscopy, voice therapy, and surgery. 

Leadership: Seth R. Schwartz, MD, MPH (Chair), Seth M. Cohen, MD, MPH (Assistant Chair), Seth H. Dailey, MD (Assistant Chair), Richard M. Rosenfeld, MD, MPH (Methodologist)

Guideline Development Group: Ellen S. Deutsch, MD, M. Boyd Gillespie, MD, Evelyn Granieri, MD, MPH, Med, Edie R. Hapner, PhD, C. Eve Kimball, MD, Helene J. Krouse, PhD, RN, ANP-BC, J. Scott McMurray, MD, Safdar Medina, MD, Karen O'Brien, MD, Daniel R. Ouellette, MD, Barbara J. Messinger-Rapport, MD, PhD, Robert J. Stachler, MD, Steven Strode, MD, MEd, MPH, Dana M. Thompson, MD, Joseph C. Stemple, PhD, J. Paul Willging, MD, Terrie Cowley, Scott McCoy, DMA, Peter G. Bernad, MD, MPH, 


American Academy of Neurology (AAN) - Affirmation of Value April 2012
American Academy of Family Physicians June 2010
Society of Otorhinolaryngology and Head – Neck Nurses, Inc. Oct 2011
American Speech-Language-Hearing Association Nov 2011 


For Physicians
For Patients

In 2012 the ABIM Foundation launched Choosing Wisely® with a goal of advancing a national dialogue on avoiding wasteful or unnecessary medical tests, treatments and procedures.

Choosing Wisely centers around conversations between providers and patients informed by the evidence-based recommendations.

Access the AAO-HNSF Choosing Wisely List of 10 Things Providers and Patients Should Question

Examination of the larynx with mirror or fiberoptic scope is the primary method for evaluating patients with hoarseness. Imaging is unnecessary in most patients and is both costly and has potential for radiation exposure. After laryngoscopy, evidence supports the use of imaging to further evaluate 1) vocal fold paralysis, or 2) a mass or lesion of the larynx.

For Media & Public