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Page 3 of 11

4 Key Points Figure 1. Key Action Statement (KAS) Algorithm Patient Presents with Hoarseness Identify or Diagnose Dysphonia KAS1 YES KAS3 Do Not Image KAS8 KAS4a KAS5 NO KAS6 YES KAS7 NO KAS12 Alarm Symptoms* or Professional Voice? KAS2 Escalation of Care Do Not Prescribe Anti-reflux Medications Do Not Prescribe Steroids Do Not Prescribe Antibiotics Evaluation/Prevention KAS4a/9a Laryngoscopy or Referral for Laryngoscopy Improvement/ Resolution in 4 weeks? KAS13 Document Improvement/ Resolution Medical Management Voice Therapy Surgery Botulinum toxin for Laryngeal Dystonia Education/Prevention KAS6,7,8 KAS9b KAS10 Triage and Treat Based on Findings KAS11 KAS12 H&P to Evaluate Underlying Cause *Examples of Alarm Symptoms: • Stridor (breathing difficulties) • Neck mass • History of smoking • History of anterior neck, neurosurgical or thoracic surgery • Recent intubation • Unexpected weight loss • Concomitant dysphagia or dyspnea • Concomitant neurological symptoms (e.g., dysarthria)

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