Practice 10 Minute Consultation

Hoarse voice

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c522 (Published 07 April 2010) Cite this as: BMJ 2010;340:c522
  1. O Judd, specialist registrar in ENT1,
  2. I B Colvin, general practitioner 2
  1. 1Department of Otolaryngology, Derbyshire Royal Infirmary, Derby DE1 2QY
  2. 2Elizabeth Avenue Group Practice, London N1 3BX
  1. Correspondence to: O Judd owenjudd{at}doctors.org.uk
  • Accepted 4 December 2009

A 38 year old woman who is a teacher presents with a three week history of hoarse voice after a common cold. It is intermittent, with normal voice in between. She reports a sensation of having phlegm in the throat that constantly needs to be cleared.

What you should cover

Hoarseness has a prevalence of 6% in the general population, rising to 11% for professional voice users (30% of the workforce). Most episodes are benign and resolve with vocal hygiene (see box). Laryngeal cancer is an important, but rare, cause of hoarseness (5/100 000 in males and 1/100 000 in females). Most patients with laryngeal cancer have risk factors, mainly smoking, high alcohol intake, and increasing age (72% of cancers occur over the age of 60). Heavy smoking and drinking are synergistic risk factors, and together increase risk 80-fold.

Vocal hygiene advice for patients

Avoid
  • Cigarette smoke, dry atmospheres, dust, fumes

  • Alcohol, caffeine, decongestant drugs

  • Throat lozenges—they can dry out your throat

  • Gargling with aspirin

  • Fatigue, lack of sleep, and eating late at night

  • Shouting, whispering, screaming, singing, straining your …

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