Guideline sources The following summarized guidelines for the evaluation and management of dysphonia are prepared by our editorial team based on guidelines from the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF 2018). 1 Guidelines 1. Screening and diagnosis Diagnosis: identify dysphonia in patients with altered voice quality, pitch, loudness, or vocal effort impairing communication or reducing the quality of life. B 2. Diagnostic investigations History and physical examination: Elicit medical history and perform a physical examination to assess for underlying causes of dysphonia and factors modifying management, B as well as to identify factors requiring expedited laryngeal evaluation including but not limited to: recent surgical procedures involving the head neck or chest https://web.pathway.md/diseases/recSlH91IPPP5pq8u 1/4 6/29/23, 10:26 PM Dysphonia Pathway 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 professional voice use. B Diagnostic imaging: do not obtain CT or MRI before visualizing the larynx in patients with a primary voice complaint. D 3. Diagnostic procedures Laryngoscopy: consider performing diagnostic laryngoscopy at any time in patients with dysphonia. C Show 2 more 4. Medical management Acid-reducing therapy: do not use antireflux medications for the treatment of isolated dysphonia solely based on symptoms attributed to suspected GERD or laryngopharyngeal reflux, without visualization of the larynx. D Corticosteroids: do not use routine corticosteroids in patients with dysphonia before visualizing the larynx. D Antibiotics: do not use antibiotics routinely for the treatment of patients with dysphonia. D 5. Nonpharmacologic interventions Voice therapy: offer voice therapy in patients with dysphonia from a cause amenable to voice therapy. B 6. Therapeutic procedures Botulinum toxin injections: offer botulinum toxin injections, or refer to a clinician who can administer botulinum toxin injections, for the treatment of dysphonia caused by spasmodic dysphonia or other types of laryngeal dystonia. B 7. Surgical interventions Indications for surgery: offer surgery as a therapeutic option in patients with dysphonia with conditions amenable to surgical intervention, such as suspected malignancy, symptomatic benign vocal fold lesions not responding to conservative management, or glottic insufficiency. B https://web.pathway.md/diseases/recSlH91IPPP5pq8u 2/4 6/29/23, 10:26 PM Dysphonia Pathway 8. Patient education General counseling: counsel patients with dysphonia on control/preventive measures. B 9. Follow-up and surveillance Serial clinical assessment: document resolution, improvement, or worsening symptoms of dysphonia or change in the quality of life in patients with dysphonia after treatment or observation. B Clinical findings Symptoms Past medical history Aphonia ALS Change in voice Acromegaly Hoarseness Allergy Amyloidosis Past events Eosinophilic granulomatosis with polyangiitis Recent intubation Gastroesophageal reflux Hypothyroidism Laryngeal cancer Laryngitis Laryngopharyngeal reflux Multiple sclerosis Myasthenia gravis Parkinson's disease Recurrent laryngeal nerve injury Rheumatoid arthritis SLE Sarcoidosis Sj gren's disease Stroke Upper respiratory tract infection Vocal cord nodule Vocal cord paralysis Vocal fold paralysis Vocal fold polyp Social history Voice overuse References https://web.pathway.md/diseases/recSlH91IPPP5pq8u 3/4 6/29/23, 10:26 PM Dysphonia Pathway 1. Stachler RJ, Francis DO, Schwartz SR et al. Clinical Practice Guideline: Hoarseness Dysphonia) (Update). Otolaryngol Head Neck Surg. 2018 Mar;158 1_suppl):S1 S42. Open https://web.pathway.md/diseases/recSlH91IPPP5pq8u 4/4