- Red flags (please see figure 1)
- Presence of heart burn?
- Any recent upper respiratory infection ?
- steroid inhaler user? Gargling after each use?
- Recent injury / surgery to the neck?
- Recent intubation?
- Other systemic diseases: hypothyroidism, neurological disease such as parkinson's disease or myasthenia graves, and inflammatory or autoimmune conditions, such as rheumatoid arthritis.
Examination
- listen to the voice and note the quality, pitch and volume
- Ask the patient to sustain the vowel sound 'ah' for as long as they can and time it, < 8 secs is usually pathological
- Ask the patient to cough and listen to the quality
- During the respiratory examination, listen to stridor
- palpate the neck and thyroid for any masses
- other systems, if indicated
Investigation and management
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Reference:
APF 2016 June Approach to hoarseness
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