Adults and children with altered voice.

Red Flags

Persistently altered voice for

  • More than 6 weeks
  • More than 3 weeks with any of the following
    • History of smoking/alcohol
    • Referred otalgia
    • Dysphagia
    • Stridor
    • Cervical lymph nodes

Refer as 2ww head for neck.


Trial of lifestyle advice

  • Advise against over use and abuse of voice
  • Check thyroid status
  • Hydration
  • Reflux treatment
  • Steroid inhaler technique review, consider use of a spacer
  • Consider chest x-ray
  • Smoking cessation if relevant

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 consultant opinion in ENT.

Chapter 12- ENT


Referral Criteria

  • Persistant 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-TSDFT-Torbay-RA9
For adults
  • e-Referral service selection
    • Specialty - ENT
    • Clinic type - Throat
    • Service - DRSS-South Devon & Torbay-Ear Nose and Throat- Devon CCG -15N
For children

e-Referral selection

  • Speciality: Children's & Adolescent Services
  • Clinic type: ENT
  • Service: DRSS-South Devon & Torbay-Children's & Adolescent Services- Devon CCG - 15N

Referral Forms

DRSS Referral Form

Torbay and South Devon seeking advice form

Supporting Information

Patient Information

Hoarseness -patient information leaflet (ENT net website)

Common problems with the voice - patient leaflet (ENT net website)

Pathway Group

This guideline has been signed off by South Devon and Torbay CCG

Publication date: October 2017


Home > Referral > SDevon & Torbay > ENT & Audiology > Dysphonia


  • First line
  • Second line
  • Specialist
  • Hospital