Dysphonia/Altered voice in Adults and Children


Adults and children with altered voice.

Red Flags

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
  • 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-NEW Devon CCG
For adults

e-Referral service selection:

  • Specialty - ENT
  • Clinic type - Throat
  • Service - DRSS-Western-ENT- Devon CCG-15N
For children

e-Referral service selection:

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

Referral Forms

Head and Neck Cancer 2ww

DRSS referral 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 the Western Locality on behalf of NEW Devon CCG.

Publication date: March 2016

Updated: January 2021

Last updated: 29-01-2021


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