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Dysphonia

Guidelines

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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Screening and diagnosis

Diagnosis: as per AAO-HNSF 2018 guidelines, identify dysphonia in patients with altered voice quality, pitch, loudness, or vocal effort impairing communication or reducing the QoL.
B
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Diagnostic investigations

History and physical examination: as per AAO-HNSF 2018 guidelines, 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

Diagnostic procedures

Laryngoscopy: as per AAO-HNSF 2018 guidelines, consider performing diagnostic laryngoscopy at any time in patients with dysphonia.
C
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Medical management

Acid-reducing therapy: as per AAO-HNSF 2018 guidelines, 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

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  • Corticosteroids

  • Antibiotics

Nonpharmacologic interventions

Voice therapy: as per AAO-HNSF 2018 guidelines, offer voice therapy in patients with dysphonia from a cause amenable to voice therapy.
B

Therapeutic procedures

Botulinum toxin injections: as per AAO-HNSF 2018 guidelines, 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

Surgical interventions

Indications for surgery: as per AAO-HNSF 2018 guidelines, 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

Patient education

General counseling: as per AAO-HNSF 2018 guidelines, counsel patients with dysphonia on control/preventive measures.
B

Follow-up and surveillance

Clinical follow-up: as per AAO-HNSF 2018 guidelines, document resolution, improvement, or worsening symptoms of dysphonia or change in the QoL in patients with dysphonia after treatment or observation.
B