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EBP Compendium: Summary of Clinical Practice Guideline

American Academy of Otolaryngology—Head and Neck Surgery
Clinical Practice Guideline: Hoarseness (Dysphonia)

Schwartz, S. R., Cohen, S. M., et al. (2009).
Otolaryngology - Head and Neck Surgery, 141(3, Supplement 2), S1-S31.

AGREE Rating: Highly Recommended


This guideline provides recommendations pertaining to the management of hoarseness. The recommendations do not apply to individuals with a history of laryngectomy, craniofacial anomalies, velopharyngeal insufficiency, or dysarthria. However, it does discuss the relevance of these conditions in managing patients with hoarseness. Additionally, some recommendations may exclude individuals with specific conditions. The intended audience for this guideline includes “all clinicians who are likely to diagnose and manage patients with hoarseness and applies to any setting in which hoarseness would be identified, monitored, treated, or managed” (p. S2). Each statement is graded as a "strong recommendation",  “recommendation,” or “option.”


  • Assessment/Diagnosis
    • Assessment Areas
      • Speech/Voice
        • “Clinicians should diagnose hoarseness (dysphonia) in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related [quality of life] QOL” (Recommendation Statement) (p. S5).
        • “Clinicians should assess the patient with hoarseness by history and/or physical examination for factors that modify management such as one or more of the following: recent surgical procedures involving the neck or affecting the recurrent laryngeal nerve, recent endotracheal intubation, radiation treatment to the neck, a history of tobacco abuse, and occupation as a singer or vocal performer” (Recommendation Statement) (p. S8).
    • Assessment Instruments
      • Speech/Voice
        • Laryngoscopy
          • “Clinicians may perform laryngoscopy, or may refer the patient to a clinician who can visualize the larynx, at any time in a patient with hoarseness” (Option Statement) (p. S9).
          • “Clinicians should visualize the patient’s larynx, or refer the patient to a clinician who can visualize the larynx, when hoarseness fails to resolve by a maximum of three months after onset, or irrespective of duration if a serious underlying cause is suspected” (Recommendation Statement) (p. S9).
          • “Clinicians should not obtain computed tomography (CT) or magnetic resonance imaging (MRI) of the patient with a primary complaint of hoarseness prior to visualizing the larynx” (Recommendation Statement) (p. S12).
          • “Clinicians should visualize the larynx before prescribing voice therapy and document/communicate the results to the speech-language pathologist” (Recommendation Statement) (p. S17).
  • Treatment
    • Speech/Voice
      • “Clinicians should advocate voice therapy for patients diagnosed with hoarseness (dysphonia) that reduces voice-related [quality of life] QOL” (Strong Recommendation Statement) (p. S17).
      • "Clinicians may educate/counsel patients with hoarseness about control/preventive measures” (Option Statement) (p. S21). 

Keywords: Head and Neck Cancer; Spasmodic Dysphonia; Voice Disorders

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Added to Compendium: November 2011

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