Hoarseness is a common presentation in primary care practices. Combined with other voice-related changes, it falls under the umbrella diagnosis of
dysphonia.
Hoarseness has a number of causes, ranging from simple inflammatory processes to less common
psychiatric disorders to more serious systemic, neurologic, or cancerous conditions. Medication-induced
hoarseness is common and should be considered. The initial evaluation begins with a targeted history and physical examination, while also looking for signs of potential systemic etiologies. Treatment should begin with voice rest, especially avoidance of whispering, and
conservative management directed toward a presumptive cause. For example,
proton pump inhibitors are appropriate for
hoarseness due to reflux, and proper vocal hygiene is recommended for vocal abuse-related indications. In the absence of a clear indication,
antibiotics, oral
corticosteroids, and
proton pump inhibitors should not be used for the empiric treatment of
hoarseness. Direct visualization of the larynx and vocal folds, commonly mislabeled as vocal cords, should be performed within three months if an etiology has not been determined or if
conservative management has been ineffective. Patients who experience symptoms lasting longer than two weeks and who have risk factors for dysplasia (e.g., tobacco use, heavy alcohol use,
hemoptysis) may require earlier laryngoscopic evaluation. Voice
therapy is effective for improving voice quality in patients with
dysphonia if conservative measures are unsuccessful, and it can also be helpful for prophylaxis in high-risk individuals (e.g., vocalists, public speakers). Surgical management is indicated for laryngeal or vocal fold dysplasia or
malignancy,
airway obstruction, or benign pathology resistant to
conservative treatment.