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Hoarseness affects nearly one\u2010third of the population at some point in their lives. This guideline applies to all age groups evaluated in a setting where hoarseness would be identified or managed. It is intended for all clinicians who are likely to diagnose and manage patients with hoarseness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose:<\/jats:title><jats:p>The primary purpose of this guideline is to improve diagnostic accuracy for hoarseness (dysphonia), reduce inappropriate antibiotic use, reduce inappropriate steroid use, reduce inappropriate use of anti\u2010reflux medications, reduce inappropriate use of radiographic imaging, and promote appropriate use of laryngoscopy, voice therapy, and surgery. In creating this guideline the American Academy of Otolaryngology\u2014Head and Neck Surgery Foundation selected a panel representing the fields of neurology, speech\u2010language pathology, professional voice teaching, family medicine, pulmonology, geriatric medicine, nursing, internal medicine, otolaryngology\u2013head and neck surgery, pediatrics, and consumers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The panel made <jats:italic>strong recommendations<\/jats:italic> that 1) the clinician should not routinely prescribe antibiotics to treat hoarseness and 2) the clinician should advocate voice therapy for patients diagnosed with hoarseness that reduces voice\u2010related QOL. The panel made <jats:italic>recommendations<\/jats:italic> that 1) the clinician should diagnose hoarseness (dysphonia) in a patient with altered voice quality, pitch, loudness, or vocal effort that impairs communication or reduces voice\u2010related QOL; 2) the clinician should assess the patient with hoarseness by history and\/or physical examination for factors that modify management, such as one or more of the following: recent surgical procedures involving the neck or affecting the recurrent laryngeal nerve, recent endotracheal intubation, radiation treatment to the neck, a history of tobacco abuse, and occupation as a singer or vocal performer; 3) the clinician should visualize the patient's larynx, or refer the patient to a clinician who can visualize the larynx, when hoarseness fails to resolve by a maximum of three months after onset, or irrespective of duration if a serious underlying cause is suspected; 4) the clinician should not obtain computed tomography or magnetic resonance imaging of the patient with a primary complaint of hoarseness prior to visualizing the larynx; 5) the clinician should not prescribe anti\u2010reflux medications for patients with hoarseness without signs or symptoms of gastroesophageal reflux disease; 6) the clinician should not routinely prescribe oral corticosteroids to treat hoarseness; 7) the clinician should visualize the larynx before prescribing voice therapy and document\/communicate the results to the speech\u2010language pathologist; and 8) the clinician should prescribe, or refer the patient to a clinician who can prescribe, botulinum toxin injections for the treatment of hoarseness caused by adductor spasmodic dysphonia. The panel offered as <jats:italic>options<\/jats:italic> that 1) the clinician may perform laryngoscopy at any time in a patient with hoarseness, or may refer the patient to a clinician who can visualize the larynx; 2) the clinician may prescribe anti\u2010reflux medication for patients with hoarseness and signs of chronic laryngitis; and 3) the clinician may educate\/counsel patients with hoarseness about control\/preventive measures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Disclaimer:<\/jats:title><jats:p>This clinical practice guideline is not intended as a sole source of guidance in managing hoarseness (dysphonia). Rather, it is designed to assist clinicians by providing an evidence\u2010based framework for decision\u2010making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condition, and may not provide the only appropriate approach to diagnosing and managing this problem.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.otohns.2009.06.744","type":"journal-article","created":{"date-parts":[[2009,9,2]],"date-time":"2009-09-02T04:54:39Z","timestamp":1251867279000},"page":"1-31","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":329,"title":["Clinical Practice Guideline: Hoarseness (Dysphonia)"],"prefix":"10.1002","volume":"141","author":[{"given":"Seth R.","family":"Schwartz","sequence":"first","affiliation":[{"name":"Virginia Mason Medical Center Seattle WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth M.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Duke University School of Medicine Durham NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth H.","family":"Dailey","sequence":"additional","affiliation":[{"name":"University of Wisconsin School of Medicine and Public Health Madison WI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard M.","family":"Rosenfeld","sequence":"additional","affiliation":[{"name":"SUNY Downstate Medical College and Long Island College Hospital Brooklyn NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen S.","family":"Deutsch","sequence":"additional","affiliation":[{"name":"Alfred I duPont Hospital for Children Wilmington DE"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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