CHFT: HOARSE VOICE IN ADULTS PATHWAY ←Click to view pathway image Source of image goes here SelectHoarse voice which is persistentHoarse voice which is intermittent ↓ Persistent unexplained hoarse voice for more thant 3 weeks in a patient 45 years and over?YesNo ↓ Non-sinister features include a history of: Occupational voice user Vocal abuse Steroid inhaler use Recent respiratory tract infection Check thyroid status Does the patient have a history suggestive of a non sinister cause?*NoYes*No, and after 4 weeks of persistent hoarse voice ↓ ↓ ⤷ CONSIDER URGENT REFERRAL TO ENT UNDER 2 WEEK WAIT Voice care - provide patient information leaflet Optimise steroid dose, device and technique Hydration - reduce caffiene and alcohol, have regular sips of water Anti-reflux measures if appropriate including Gaviscon qds +/- PPI Chest X-ray if lung pathology suspected ↓ Follow-up 6-8 weeks or sooner if any worsening symptoms Symptoms resolved?NoYes ↓ REFER TO ENT CLINIC NO FURTHER INTERVENTION