Referral

Dysphonia

Scope

This guideline covers adults and children with altered voice.

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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