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Last updated: 30 March, 2020 15:59pm

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Hoarse Voice (Dysphoria) in Adults – Information for GPs

Referral Criteria / Commissioning position

Referral to secondary care:

  • Emergency:
    • Associated with stridor and possible airway obstruction
  • Two Week Rule:
    • A prolonged continuous hoarse voice sometimes with sinister features such as unilateral pain with no obvious case. The usual advice is a continuous hoarse voice for longer than three weeks
  • Routine:
    • Non-sinister hoarse voice which is not settling with simple conservative measures and may benefit from inspection of their vocal cords and/or speech and language input and further investigation

Investigations prior to referral

CXR – excludes sinister non-ENT causes

Information to include in referral letter

Prior to referral CXR to be performed to exclude sinister non-ENT causes

The GP referral letter should contain:

  • Duration of hoarseness
  • Impact on quality of life – is hoarseness present all the time?
  • Any associated features
  • Routine bloods including TFTs
  • Occupation
  • Treatments tried already and their effects
  • Past medical/surgical history
  • Current regular medication
  • BMI
  • Smoking status
  • Alcohol consumption

Patient Information


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