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 consultant opinion in ENT.

12. Ear, nose & oropharynx

Referral Criteria

• Altered voice for more than 3 weeks and ongoing symptoms

• No red flags present

• Trial of lifestyle advice in primary care

Referral Instructions

2WW referrals

e-Referral service selection:

• Specialty: 2ww
• Clinic type: Head and Neck
• Service: DRSS-Western-2WW Head & Neck-NHS Devon ICB

For adults

e-Referral service selection:

• Specialty - ENT
• Clinic type - Throat
• Service - DRSS-Western-ENT- Devon ICB-15N

For children

e-Referral service selection:

• Specialty: Children's & Adolescent Services
• Clinic Type: ENT
• Service: DRSS-Western-ENT - (Children)-Devon ICB-15N

Referral Forms

Head and Neck Cancer 2ww

DRSS Referral Form

Patient Information

Hoarseness -patient information leaflet (ENT net website)

Throat (ENT net website)

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: March 2016

Updated: January 2021