A useful reminder about patients who complain of a hoarse voice:
- Red flag symptoms are persistent hoarseness for more than three weeks, difficulty or pain on swallowing, haemoptysis, earache with normal otoscopy, weight loss, and heavy smoking or alcohol intake
- Urgent ! chest x ray is needed if hoarseness persists for more than 3 weeks (especially if the patient is a heavy drinker, smoker, or over 50 years old)
- If the x ray is positive, refer urgently for suspected lung cancer. If it's negative, refer urgently for suspected head and neck cancer
- Routine ENT referral is advised for recurrent but non persistent (less than 3 weeks) hoarseness with no red flag symptoms
- Advise patients to stop smoking, reduce alcohol intake, and improve vocal hygiene
- Treat any exacerbating conditions such as oral thrush, asthma, or rhinitis
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