Clinical Practice Guideline: Hoarseness (Dysphonia)
This Clinical Practice Guideline is currently undergoing an update.
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
Timeline: Public Comment January 2017 (tentative) - Publication July 2017 (tentative)
The original guideline was published as a supplement in the September 2009 issue of Otolaryngology - Head and Neck Surgery.
The information below is from the original publication.
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,
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.
Endorsements:
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
Physician Resources
- Published Guideline
- Research Gaps
- Articles of Interest
- Prevalence and Causes of Dysphonia in a Large-Treatment Seeking Population
- The impact of laryngeal disorders on work-related dysfunction
- Direct health care costs of laryngeal diseases and disorders
- Factors Influencing the Healthcare Expenditures of Patients with Laryngeal Disorders
- Assessing factors related to the pharmacologic management of laryngeal diseases and disorders
- Prescribing patterns of primary care physicians and otolaryngologists in the management of laryngeal disorders
- Delayed Otolaryngology Referral for Voice Disorders Increases Health Care Costs
- Change in diagnosis and treatment following specialty voice evaluation: A national database analysis
- Frequency and factors associated with use of videolaryngostroboscopy in voice disorder assessment
- Diagnosis change in voice-disordered patients evaluated by primary care and/or otolaryngology: a longitudinal study.
- Factors influencing referral of patients with voice disorders from primary care to otolaryngology
- Recent studies of interest
- Slide set available: contact Sarah O'Connor soconnor@entnet.org for more information
- Education Opportunities
- AAO-HNSF Continuing Medical Education (CME) visit www.academyu.org (Academy login required)
- None currently available
- ABOto Maintenance of Certification (MOC) visit www.aboto.org (ABOto login required)
- Self-Assessment Modules (SAMs) (ABOto MOC participation required)
- Patient with Dysphonia
- Patient with Hoarseness
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
Access the guidelines via the National Guidelines Clearinghouse.