Clinical Practice Guideline: Hoarseness (Dysphonia) (Update) Executive Summary

• Published in: Otolaryngology-head and neck surgery 2018-03, Vol.158 (3), p.409-426
• Main Authors: Stachler, Robert J., Francis, David O., Schwartz, Seth R., Damask, Cecelia C., Digoy, German P., Krouse, Helene J., McCoy, Scott J., Ouellette, Daniel R., Patel, Rita R., Reavis, Charles (Charlie) W., Smith, Libby J., Smith, Marshall, Strode, Steven W., Woo, Peak, Nnacheta, Lorraine C.
• Format: Article
• Language: English
• Subjects: dysphonia; Evidence-Based Medicine; guidelines; hoarseness; Hoarseness - therapy; Humans; laryngitis; Quality Improvement; Quality of Life; voice; voice change; voice disorders; voice disturbance
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599817751031

Objective This guideline provides evidence-based recommendations on treating patients presenting with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third of the population at some point in its life. This guideline applies to all age groups evaluated in a setting where dysphonia would be identified or managed. It is intended for all clinicians who are likely to diagnose and treat patients with dysphonia. Purpose The primary purpose of this guideline is to improve the quality of care for patients with dysphonia, based on current best evidence. Expert consensus to fill evidence gaps, when used, is explicitly stated and supported with a detailed evidence profile for transparency. Specific objectives of the guideline are to reduce inappropriate variations in care, produce optimal health outcomes, and minimize harm. For this guideline update, the American Academy of Otolaryngology—Head and Neck Surgery Foundation selected a panel representing the fields of advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric medicine, internal medicine, laryngology, neurology, otolaryngology–head and neck surgery, pediatrics, professional voice, pulmonology, and speech-language pathology. Action Statements The guideline update group made strong recommendations for the following key action statements (KASs): (1) 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. (2) Clinicians should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy. The guideline update group made recommendations for the following KASs: (1) Clinicians should identify dysphonia in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces quality of life (QOL). (2) Clinicians should assess the patient with dysphonia by history and physical examination for underlying causes of dysphonia and factors that modify management. (3) Clinicians should perform laryngoscopy, or refer to a c