Rule out Cancer Early

Hoarseness—Causes and Treatments by Prof. Dr. med. Rudolf Reiter, Prof. Dr. med. Thomas Karl Hoffmann, Priv.-Doz. Dr. med. Anja Pickhard, and Prof. Dr. med. Sibylle Brosch in issue 19/2015

The authors deserve thanks for their comprehensive overview of the wide range of possible causes of hoarseness (1). Apart from histologically benign organic lesions, functional and other causes, especially malignancies, such as cancer of the larynx and hypopharynx as well as apical lung cancer, should always be addressed early in the workup, even in the absence of risk factors. The most common head and neck cancers are located in the larynx and the only early symptom in patients with glottic cancer is dysphonia. Fortunately, this often leads to early diagnosis and initiation of treatment, contributing largely to the good to very good prognosis of these tumors. Thus, it is vital to avoid any unnecessary delay in diagnosis. The cited US guideline (2) making the (non-consensus-based) recommendation to only use indirect laryngoscopy for diagnosis in patients with hoarseness persisting for more than 3 months has been a matter of strong controversy after its publication, particularly because of the literature it is based on, and thus should be viewed critically (3). This position is supported by a large survey among members of the American Laryngological Association, the American Broncho-Esophagological Association and the European Laryngological Society, where the respondents clearly called for the use of indirect laryngoscopy in patients with persistent dysphonia during the first month after onset, for the above mentioned reasons (4).

DOI: 10.3238/arztebl.2016.0070b

Dr. med. Jan Peter Thomas

Prof. Dr. med. Stefan Dazert

Klinik für Hals-Nasen- und Ohrenheilkunde

Kopf- und Halschirurgie der Ruhr-Universität Bochum, Germany

Conflict of interest statement

The authors declare that no conflict of interest exists.

References

1. Reiter R, Hoffmann TK, Pickhardt A, Brosch S: Hoarseness—causes and treatments. Dtsch Arztebl Int 2015; 112: 329–37

2. Schwartz SR, Cohen SM, Dailey SH, et al.: Clinical practice guidelines: hoarseness (dysphonia). Otolaryngol Head Neck Surg 2009; 141: 1–31

3. Paul BC, Rafii B, Achlatis S, et al.: Morbidity and patient perception of flexible laryngoscopy. Ann Otol Rhinol Laryngol 2012; 121: 708–13

4. Sadoughi B, Fried MP, Sulica L, Blitzer A: Hoarseness evaluation: a transatlantic survey of laryngeal experts. Laryngoscope 2014: 124: 221–6