Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • concerning features of obstructive airway:
    • acute hoarseness
    • acute or sudden voice change
    • difficulty breathing
    • drooling
    • severe odynophagia
    • stridor

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant metropolitan Local Health Network switchboard and ask to speak to the relevant specialty service.

If clinical advice is required urgently or out of hours, please contact Flinders Medical Centre or the Women’s and Children’s Hospital.

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Women's and Children's Health Network

Category 1 (appointment clinically indicated within 30 days)

  • presentations with one or more concerning features:
    • dysphagia
    • neck lump
    • persistent hoarseness greater than 3 weeks
    • unilateral symptoms of throat pain or ear pain
  • stridor/choking when feeding
  • unresolved voice and persistent hoarseness for a minimum of 3 weeks with a history of:
    • recent intubation, and/or
    • recent cardiac, and/or
    • recent thyroid surgery

Category 2 (appointment clinically indicated within 90 days)

  • persistent moderate to severe hoarseness and voice loss greater than 4 weeks
  • suspicion of any of the following:
    • papilloma
    • thrush
    • vocal cord palsy

Category 3 (appointment clinically indicated within 365 days)

  • chronic hoarseness without concerning features

For more on outpatient referrals, see the general referral information page.

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

  • identifies as Aboriginal and/or Torres Strait Islander  
  • identify within your referral if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf
  • interpreter required
  • age
  • past medical/surgical/neurological history
  • onset, duration, and progression of symptoms, including:
    • define patient's meaning of 'hoarseness'
    • history of overuse of voice (shouting/yelling)
    • history of vocal cord cysts or nodules
    • history of gastro-oesophageal reflux
    • weak cry, choking during feeding,
    • cyanotic or blue spells
  • management history including treatments trialled/implemented prior to referral including allied health summaries
  • naso-oropharyngeal examination
  • physical examination:
    • exclude viral or bacterial infection
    • signs of airway obstruction e.g. listen to the patient's voice, and assess cough and swallowing
    • concerning features
    • neurological assessment
  • neck examination:
    • scars
    • lymph nodes
    • thyroid gland
    • localised tenderness/pain radiating to ear
  • relevant diagnostic/imaging reports including location of company and accession number

Additional information to assist triage categorisation

  • speech pathology report/summary

Clinical management advice

Initial approaches for managing dysphonia include:

  • addressing potential bacterial infections, such as sinusitis with noticeable postnasal drip
  • be attentive to potential viral infections and provide supportive care as needed
  • advise voice rest to facilitate recovery
  • if voice quality is a concern, consider a speech pathology evaluation

Assess for the presence of:

  • gastroesophageal reflux
  • hypothyroidism
  • oropharyngeal issues that might lead to a muffled voice
  • possible recurrent laryngeal nerve damage
  • chronic rhinosinusitis if appropriate

Please utilise the relevant Aboriginal Liaison Units (ALU) to provide support to Aboriginal families.

Clinical resource

Consumer resources