A change in voice
### What you need to know 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 c