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Dysphonia

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).
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Guidelines

1.Screening and diagnosis

Diagnosis: identify dysphonia in patients with altered voice quality, pitch, loudness, or vocal effort impairing communication or reducing the QoL.
B
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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,
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
recent endotracheal intubation
presence of concomitant neck mass
respiratory distress or stridor
history of tobacco abuse
professional voice use.
B

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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.
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

8.Patient education

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