Intended for healthcare professionals

  1. Education
  2. A change in voice
  3. A change in voice
Practice 10-Minute Consultation

A change in voice

BMJ 2025; 388 doi: https://doi.org/10.1136/bmj-2024-079623 (Published 21 January 2025) Cite this as: BMJ 2025;388:e079623
  1. Chris Hogan, ear, nose, and throat specialist registrar1,
  2. Marion Alston, principal speech and language therapist1,
  3. Andrew Costerton, patient author2,
  4. Bengi Beyzade, general practitioner3,
  5. Nick J I Hamilton, consultant laryngologist, associate professor (laryngology)1 4
  1. 1Royal National ENT and ED Hospitals, University College London NHS Foundation Trust, London, UK
  2. 2Patient author, London, UK
  3. 3Clerkenwell Medical Practice, London, UK
  4. 4UCL Division of Surgery & Interventional Sciences, London, UK
  1. Correspondence to: C Hogan c.hogan1{at}nhs.net

What you need to know

  • A patient’s voice should facilitate participation in normal social and professional activities and not be impaired by hoarseness, weakness, fatigueability, or pain

  • The most common causes of voice change are benign (non-malignant), and include acute or chronic laryngitis, age related changes (presbyphonia), muscle tension dysphonia, and benign vocal fold lesions

  • Red flag features for malignancy include duration of symptoms greater than three weeks, unexplained otalgia, and feeling of something in the throat with presence of blood

  • Patients with a benign aetiology to their dysphonia may benefit from vocal hygiene measures.

A 45 year old man presents to his general practitioner with a three month history of hoarse voice. The onset was over a short time and was predated by five days of coryzal symptoms. He has no past medical history, takes no regular medications, and smokes 10 cigarettes a day.

A change in voice, or dysphonia, describes a perceived alteration in vocal function and can include changes in voice clarity, pitch, loudness, and fatigueability. This term is preferred to vocal hoarseness, which refers to a change in the clarity of the voice only. Dysphonia can have a substantial impact on social and professional quality of life leading to anxiety, depression, social isolation, and inability to work or attend education.1

Dysphonia is common, and in one large retrospective analysis of US insurance claims data, prevalence was 1% of people aged up to 65 years old, with a lifetime incidence of about 30%.2 Clinical assessment of the dysphonic patient can be challenging for a clinician who is unable to visualise the larynx. Here, we aim to help healthcare practitioners working in primary care and the non-specialist setting to understand the clinical features of benign (non-malignant) disease and features that warrant onward referral to ear, nose, throat specialists.

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