Persistent hoarseness — RACGP Fellowship MCQ

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ModerateENT, OphthalmologyPersistent hoarsenessRACGP Fellowship

A 36-year-old teacher presents with hoarseness for seven weeks following an upper respiratory infection. He does not smoke and denies dysphagia, neck mass, or haemoptysis. Voice rest has not improved his symptoms. What is the most appropriate management?

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Correct answer: D — Refer for laryngoscopy to visualise the larynx

Explanation lettering: B = shown as A · D = shown as B · A = shown as C · C = shown as D

The correct answer is C. RACGP guidance explicitly recommends referral for direct laryngeal visualisation when hoarseness persists beyond three weeks. This patient's seven-week duration far exceeds that threshold and warrants laryngoscopy to visualise the larynx and identify any structural, infectious, or neoplastic pathology. Antibiotics (A) are inappropriate for non-infectious persistent hoarseness and delay diagnosis. Corticosteroids (B) are not first-line without a confirmed diagnosis and should not be given indefinitely. Reassurance alone (D) risks missing treatable or serious pathology—a cautionary example from RACGP literature involved delayed diagnosis of fungal laryngitis. Thyroid function tests (E) are not the primary investigation for persistent hoarseness, though they may have a supportive role if other clinical features suggest thyroid disease. Professional voice use (teacher) further supports the need for prompt laryngoscopy.

Reference: Royal Australian College of General Practitioners (RACGP). Hoarseness: An approach for the general practitioner. Australian Family Physician. 2016. https://www.racgp.org.au/getattachment/9ee95633-5028-4461-87bc-fb896d4fc03f/Hoarseness-An-approach-for-the-general-practitione.aspx