What are the indications for referring a patient with laryngitis to an ENT specialist?

Indications for referring a patient with laryngitis to an ear, nose, and throat (ENT) specialist include:

• Persistent and unexplained hoarseness lasting more than 3 weeks, especially in patients aged 45 and over, as this may indicate possible laryngeal cancer and warrants a suspected cancer pathway referral.
• Hoarseness associated with other concerning symptoms such as dysphagia, odynophagia, unexplained weight loss, or neck lumps.
• Recurrent or severe symptoms that do not respond to initial management in primary care.
• Presence of red flags such as airway compromise, stridor, or significant voice changes impacting breathing or swallowing.
• Adults with persistent middle ear effusion or unexplained otitis media symptoms that may be related to underlying nasopharyngeal pathology.

Referral should be considered urgently if cancer is suspected based on these features, following NICE suspected cancer referral guidelines.

Summary: Persistent unexplained hoarseness over 3 weeks in adults ≥45 years, especially with additional red flags or risk factors, mandates ENT referral to exclude malignancy or other serious pathology ⁴.