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

Reference:

• (1) Wood JM, Athanasiadis T, Allen J. Laryngitis. BMJ. 2014;349:g5827

• (2) NICE (June 2015). Suspected cancer: recognition and referral.