Table 22

Investigation and management of hoarseness

InvestigationsPotential resultsClinical management plan
Actions from history, medication and dietary assessment
History findingsHoarsenessVoice hygiene advice:
  1. Adequate hydration.

  2. Avoid vocal strain (shouting, throat clearing, excessive voice use).

  3. Smoking cessation advice if a smoker.

  4. Alcohol reduction (alcohol is an irritant and dehydrating).

  5. Refer to SLT.

Dysphagia/aspirationDiscuss with supervising clinician within 24 hours.
Presence of laryngeal obstruction
  • Dyspnoea, stridor, wheeze, exertional dyspnoea, anxiety or signs of hypoxia

  • Dysphagia or drooling

  • Facial or oral oedema

This is an emergency. Refer to ENT team immediately.
Presence of other ENT symptoms
  • Throat or ear pain

  • Nasal blockage

Refer to the ENT team requesting an appointment within 2 weeks.
First line
LaryngoscopyVocal cord palsyCT scan and refer to cancer MDT within 2 weeks. Referral to SLT.
CT chest, abdomen, pelvisMalignancy/tumour recurrenceDiscuss and refer urgently to the appropriate cancer MDT requesting an appointment within 2 weeks.
Superior vena cava obstructionThis is an emergency. Contact acute oncology service immediately.
Second line
OGDGORDStart PPI or H2 antagonist. If following oesophagectomy, consider promotility agents (see p. 78).
Cervical inlet patchTreat with PPI or ablation.
Third line
If normal investigations/no response to interventionReassure.
  • CT, computerised tomography; ENT, ear, nose and throat; GORD, gastro-oesophageal reflux disease; H2, histamine receptor 2; MDT, multidisciplinary team; OGD, upper GI endoscopy (oesophago-gastroduodenoscopy); PPI, proton pump inhibitor; SLT, speech and language therapy.