Hoarseness – Take-home points

 

Red flag symptoms are persistent hoarseness for more than three weeks, difficulty or pain on swallowing, haemoptysis, earache with normal otoscopy, weight loss, and heavy smoking or alcohol intake

Urgent chest x ray is needed if hoarseness persists for more than 3 weeks (especially if the patient is a heavy drinker, smoker, or over 50 years old)

If the x ray is positive, refer urgently for suspected lung cancer. If it's negative, refer urgently for suspected head and neck cancer

Routine ENT referral is advised for recurrent but non persistent (<3 weeks) hoarseness with no red flag symptoms

Advise patients to stop smoking, reduce alcohol intake, and improve vocal hygiene

Treat any exacerbating conditions such as oral thrush, asthma, or rhinitis 

5 Minutes of General Practice from BMJ