Red Flags in adults

Persistently altered voice for more than 3 weeks with a negative CXR: consider referral via Head and Neck Cancer 2ww

Please note that a sinister cause is more likely if:

• History of smoking/alcohol
• Referred otalgia
• Dysphagia
• Stridor
• Cervical lymph nodes

Urgent

Episodic or Variable dysphonia for 3 weeks and:

• Professional voice user, e.g., singer or teacher
• High psychosocial distress

Trial of lifestyle advice

• Advise against over use and abuse of voice
• Check thyroid status
• Hydration
• Reflux treatment
• Steroid inhaler technique review, consider use of a spacer
• Consider chest x-ray
• Smoking cessation if relevant

Follow up in 4 weeks or sooner if worsening

• Check for new red flags

If symptoms resolve, plan to review the patient in primary care if indicated.

Patients with ongoing symptoms should be referred for a consultant opinion in ENT.

Chapter 12- ENT

Referral Criteria

• Persistent altered voice
• No red flags present and no improvement following the above treatment

Referral Instructions

2WW referrals

e-Referral Service selection

• Specialty: 2ww
• Clinic type: Head and Neck
• Service: 2ww - Head and Neck – RD&E

For adults

e-Referral service selection

• Specialty - ENT
• Clinic type - Throat
• Service - DRSS-Eastern-Ear Nose and Throat-Devon ICB- 15N

For children

e-Referral selection

• Speciality: Children's & Adolescent Services
• Clinic type: ENT
• Service: DRSS-Eastern-Child & Adolescent Services-Devon ICB - 15N

Referral Form

DRSS Referral Form

Patient Information

Hoarseness -patient information leaflet (ENT Health website)

Throat (ENT Health website)

Evidence

This guideline has been developed by Royal Devon and Exeter Healthcare Foundation Trust based on local guidelines.

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: December 2016

Updated: April 2021

Reviewed: April 2024