FFinalistSouthampton · 2027
ENT
AKT · ENT/Throat & airwaylow yield

Laryngitis & hoarseness

Inflammation of the larynx / vocal-cord pathology

Overview

Hoarseness (dysphonia) from laryngeal inflammation — usually acute viral laryngitis (self-limiting) or from voice overuse, reflux, or smoking. The crucial rule: PERSISTENT hoarseness (>3 weeks), especially in a smoker/drinker, is laryngeal cancer until proven otherwise and needs urgent ENT.

Recognise

  • Hoarse voice ± sore throat, with a recent URTI (acute viral laryngitis), voice overuse, or reflux
  • Acute laryngitis is self-limiting over ~1–2 weeks
  • Chronic causes: smoking, reflux (posterior laryngitis), vocal nodules/polyps, vocal-cord palsy, and laryngeal carcinoma

Red flags

  • Hoarseness persisting >3 weeks (especially a smoker/drinker), neck lump, dysphagia, otalgia, haemoptysis, or stridor → 2-week-wait ENT (laryngeal cancer)

Differentials & how to tell them apart

Laryngeal carcinomapersistent (>3 weeks) hoarseness in a smoker/drinker — must scope to exclude
Vocal-cord nodules/polypsvoice overuse (singers/teachers), benign
Recurrent laryngeal nerve palsya breathy voice; look for a lung apex/mediastinal or thyroid-surgery cause
Reflux laryngitisposterior laryngeal changes, throat clearing, worse on waking

Investigations

Acute viral laryngitis: clinical. Persistent hoarseness → ENT for laryngoscopy (visualise the cords). Consider a vocal-cord palsy cause (e.g. lung apex/mediastinal lesion compressing the recurrent laryngeal nerve → chest imaging).

Management

Voice rest for acute viral laryngitis; urgent ENT if hoarse >3 weeks

  1. 1Acute viral laryngitis → reassure, voice rest and hydration (self-limiting). Address contributors (reflux, voice misuse, smoking).Gate: Hoarseness lasting >3 WEEKS — especially in a smoker or drinker — is a 2-week-wait red flag for LARYNGEAL CANCER and must be scoped (laryngoscopy), not just rested
  2. 2Persistent hoarseness → ENT laryngoscopy; a confirmed vocal-cord palsy without an obvious cause → image the recurrent laryngeal nerve pathway (chest/neck); speech therapy for benign lesions.
Voice rest + hydration — acute viral laryngitis is self-limiting
Treat the cause — reflux measures/PPI; speech therapy for nodules; stop smoking

Key points

Acute hoarseness is usually viral and self-limiting; the exam point is the >3-week red-flag rule for laryngeal cancer. A unilateral cord palsy is a clue to a chest/mediastinal lesion.

Monitor & prognosis

Resolution of acute cases; scope findings for persistent cases.

Acute laryngitis resolves; prognosis of persistent causes depends on the diagnosis.

Source: NICE NG12 (suspected cancer); NICE CKS Hoarseness