Many patients presenting with hoarseness do not have an underlying head and neck malignancy. Hence, ordering imaging initially does not help to make a diagnosis. Persistent hoarseness, lasting greater than 6 weeks, can be one of the first signs of malignancy of the larynx or voice box. This is particularly true in current or ex-smokers and individuals with a current or previous history of alcohol abuse. Laryngoscopy as part of a thorough physical examination is the best initial investigation of persistent hoarseness. If the laryngoscopy demonstrates a vocal cord paralysis or a mass/lesion of the larynx, imaging to further evaluate is evidence-based.
Sources:
Hoare TJ, et al. Detection of laryngeal cancer–the case for early specialist assessment. J R Soc Med. 1993 Jul;86(7):390-2. PMID: 8053995.
Schwartz SR, et al. Clinical practice guideline: hoarseness (dysphonia). Otolaryngol Head Neck Surg. 2009 Sep;141(3 Suppl 2):S1-S31. PMID: 19729111.
Syed I, et al. Hoarse voice in adults: an evidence-based approach to the 12 minute consultation. Clin Otolaryngol. 2009 Feb;34(1):54-8. PMID: 19260886.