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 Chest x-ray

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 specialist assessment.

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-Northern-Ear Nose and Throat - Devon ICB- 15N

For children

e-Referral selection

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

Referral Forms

DRSS Referral Form

Head & Neck 2ww referral form

Patient Information

Hoarseness (ENT Health website)

Throat (ENT Health website)

Pathway Group

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

Publication date: November 2017

Updated: April 2021

Reviewed: April 2024