When an adult smoker or ex-smoker has been hoarse for more than four weeks without an obvious cause, the next step is to see the vocal cords. An empirical course of a proton pump inhibitor, a steroid or an antibiotic delays that look and can mask a laryngeal cancer. Where flexible laryngoscopy is not available locally, refer — and say in the letter how long the hoarseness has lasted and the smoking history.
- Refer adults with hoarseness lasting over four weeks for laryngoscopy, sooner if they smoke.
- Avoid empirical PPIs, steroids and antibiotics before the larynx has been seen.
- Include duration and smoking history in the referral letter.
Why it matters
Every week of empirical treatment is a week of delay if the cause is cancer.
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