Referral if laryngeal symptoms - referral from primary care

Referral of patients with laryngeal symptoms

Persistence of laryngeal symptoms (without an obvious cause) beyond three weeks warrants laryngeal examination by an otolaryngologist

• a recent retrospective study reported that in patients who were referred to otolaryngologist with an initial diagnosis of acute laryngitis
  
  
  • three quarters had a different final laryngeal diagnosis
  • nearly half with laryngeal cancer had an initial diagnosis of either acute laryngitis or non-specific dysphonia.

The following symptoms should prompt an urgent referral to exclude malignancy.

• recent surgery involving the neck or recurrent laryngeal nerve

• recent endotracheal intubation

• radiotherapy to the neck

• history of smoking

• professional voice user (for example, singer, actor, teacher)

• weight loss

• dysphagia or odynophagia

• otalgia

• serious underlying concern by clinician (1)

Note that (2):

• NICE state that if there is persistent and unexplained hoarseness in a person 45 years and over, then consider a suspected cancer pathway referral (for an appointment within 2 weeks)

References:

1. Wood JM, Athanasiadis T, Allen J. Laryngitis. BMJ. 2014;349:g5827
2. Suspected cancer: recognition and referral. NG12 NICE guideline (2015 - last updated October 2023)