Not “hysterical” but still seen mainly in women

Last year at the Glasgow Royal Infirmary over 190 new patients presented with dysphonia (hoarseness) and were referred to speech and language therapists for voice therapy. Extrapolation from these data suggests that up to 40000 such patients are referred and treated annually in Britain. A substantial proportion suffer from functional dysphonia, in which there is neither a structural abnormality of the larynx (such as a vocal cord polyp, nodule, or papilloma) nor paralysis. As with most functional somatic symptoms, women are considerably overrepresented, in some series by a factor of eight.1

Functional dysphonia is a diagnosis of exclusion. It may be confirmed only after specialist examination of the larynx by an otolaryngologist, which means that otolaryngologists see large numbers of patients with functional dysphonia in their outpatient practice. Traditional teaching dictates that hoarseness should remain “unexplained” for only three weeks, especially in smokers.

General practitioners, however, are aware that laryngeal cancer is rare and found predominantly in older …