Hoarseness

For further detail about risk assessment of hoarseness, please see the RefHelp page on:

Neck Lump and Throat Cancer Risk Assessment.

The following is a guide and will allow you to safely reassure most patients, but we recognise that some are bothered by their symptoms to such a degree that they need secondary care management.

Acute hoarseness is almost always due to an acute viral illness (laryngitis) and this can persist for a while. Cancers are associated with persistent (rather than intermittent) hoarseness, occur in older people (mean age of diagnosis is 64 in large Scottish study) and those who smoke. A history of alcohol excess and deprivation are also significant risk factors.

Hoarseness due to infection can take some time to settle. Where there is a clear explanation for symptoms (persistent or post infection), and particularly when the person is otherwise low risk (<40, non-smoking, < 3 weeks) then it is appropriate to make a clinical judgement about duration of symptoms before referring.

Please consider other red flags particularly persistent throat pain (SoreThroat.aspx), neck lump (NeckLump.aspx), symptoms suggestive of lung cancer, or a suspicious oral lesion.

Persistent (NOT INTERMITTENT) hoarseness lasting for > three weeks should be referred urgently, suspicious of cancer (Scottish Referral Guidelines for Suspected Cancer).

But please note:

This relates to PERSISTENT rather than INTERMITTENT hoarseness
The easiest and most reliable way to risk-assess for a persistent hoarseness is to use the validated Head and Neck Cancer Risk Calculator:

http://www.orlhealth.com/risk-calculator-2.html

Who to refer:

PERSISTENT hoarseness lasting for > three weeks should be referred urgently, suspicious of cancer.

The validated head and neck risk calculator http://www.orlhealth.com/risk-calculator-2.html is the most reliable way to assess urgency and is incorporated into the SCI Gateway template.

Intermittent hoarseness only needs to be referred when it is impacting significantly on the patient’s life. These patients are likely to be seen in a voice clinic with a speech and language therapist.

Who not to refer:

Hoarseness for which there is an explanation (most commonly acute infection), and which fully resolves in 3 weeks.

Those with SYMPTOMS SUGGESTIVE OF LUNG CANCER should have an urgent CXR and be referred to the respiratory services under the lung suspicion of cancer pathway.