Dysphonia (hoarseness) can be caused by many conditions that can range from minor to very serious. A number of findings may indicate the need for an immediate referral to an otolaryngologist.
“Red flags” for a patient with dysphonia:
(1) stridor
(2) recent neck surgery or penetrating trauma, especially if near the distribution for recurrent laryngeal nerve
(3) recent endotracheal intubation
(4) radiation therapy to the neck
(5) history of smoking
(6) professional voice user (lecturer, actor, singer, etc)
(7) recent weight loss
(8) dysphagia
(9) odynophyagia
(10) otalgia
(11) neck mass
(12) clinician concern
A patient with stridor should be referred immediately. The patient may be transferred by squad if there is concern about the airway.
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