Recently, The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) issued the first and only national clinical practice guideline on hoarsenes, a condition that affects about 20 million people in the United States.

Although sometimes referred to as dysphonia, hoarseness is a symptom of altered voice quality, whereas dysphonia is a diagnosis. Hoarseness is 50% more common in women than in men and is most often seen in children; the elderly; and people who use their voices professionally, such as teachers, performers, and telemarketers.

Despite the prevalence of the problem, a recent AAO-HNSF survey found that only about 5.9% of those with hoarseness seek treatment, and almost half of adults are unaware that persistent hoarseness may be a symptom of cancer.

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The guideline, published as a supplement to the September issue of Otolaryngology-Head and Neck Surgery (2009;141:S1-S31), includes the following key points:

  • Although most hoarseness is the result of benign factors, consider the possibility of a serious underlying condition (e.g., tumor of the larynx) or medication side effects as a cause.
  • Laryngoscopy should be performed before any other imaging studies when hoarseness is the primary complaint, the patient has persistent hoarseness, or the cause is uncertain.
  • Antireflux medications should not be prescribed for hoarseness unless the patient exhibits signs or symptoms of gastroesophageal reflux disease or laryngoscopy reveals inflammation of the larynx.
  • Oral steroids or antibiotics are not recommended for the treatment of hoarseness.
  • Voice therapy, typically one or two sessions per week for four to eight weeks, is a well-established intervention for patients of all ages who have hoarseness.
  • Staying hydrated, avoiding irritants (especially tobacco smoke), undergoing voice training, and employing a microphone or other amplifying device during heavy voice use can reduce the risk of hoarseness.