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Key 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.Screening and diagnosis

Diagnosis: identify dysphonia in patients with altered voice quality, pitch, loudness, or vocal effort impairing communication or reducing the QoL.
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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,
as well as to identify factors requiring expedited laryngeal evaluation including but 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
professional voice use.

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  • Diagnostic imaging

3.Diagnostic procedures

Laryngoscopy: consider performing diagnostic laryngoscopy at any time in patients with dysphonia.
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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.

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  • Corticosteroids

  • Antibiotics

5.Nonpharmacologic interventions

Voice therapy: offer voice therapy in patients with dysphonia from a cause amenable to voice therapy.

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.

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.

8.Patient education

General counseling: counsel patients with dysphonia on control/preventive measures.

9.Follow-up and surveillance

Serial clinical assessment: document resolution, improvement, or worsening symptoms of dysphonia or change in the QoL in patients with dysphonia after treatment or observation.