Laryngology · UK
Hoarseness - diagnosis and treatment, by a consultant laryngologist.
A voice off for more than three weeks is a NICE NG12 red flag. A one-stop ENT voice clinic - history, nasendoscopy, stroboscopy and a plan - usually in a single visit.
Indicative pricing
What private hoarseness assessment and treatment costs in the UK.
Indicative ranges across our partner ENT and voice clinics.
In short
A one-stop voice clinic with flexible nasendoscopy: £300–£550, an answer the same visit.
| Service | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| ENT one-stop voice clinic (consultation + FNE) | £300–£550 | 30–45 min | Same visit |
| Consultation only | £200–£400 | 30 min | Same visit |
| Stroboscopy add-on | £150–£300 | 15 min | Same visit |
| SLT voice therapy (per session) | £75–£150 | 45–60 min | 4–8 sessions typical |
| CT neck and chest (for cord palsy) | £500–£900 | 15 min | 24–48 h report |
| Micro-laryngoscopy day-case surgery | £3,500–£8,000 | 30–60 min GA | Home same day |
| Injection medialisation (cord palsy) | £2,500–£5,000 | 20–30 min | Same visit or day case |
Prices vary by clinic, by the laryngologist and SLT involved, and by whether stroboscopy, imaging or biopsy is added. NHS assessment via the two-week-wait pathway is free at the point of care. Private day-case laryngeal surgery is typically £3,500–£8,000.
The problem
The right clinic, in one visit, before three weeks becomes six.
Hoarseness is the commonest first symptom of laryngeal cancer, and it is quietly one of the most delayed diagnoses in the UK. A voice off for more than three weeks needs a scope, not a wait.
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Off for weeks, not settling?
Beyond three weeks is a NICE NG12 trigger - especially in smokers and those over 60. We move you onto the right pathway the same week.
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Told it is “just laryngitis”?
Acute laryngitis clears in days. If yours has not, the cords need to be looked at with a flexible nasendoscope. That is the test.
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Want the surgeon and SLT together?
A one-stop voice clinic gives you the laryngologist and the specialist speech and language therapist in the same visit.
When it helps
When a voice clinic is the right step.
The situations we see most, plus the red flags that mean the two-week-wait suspected cancer pathway rather than a routine booking.
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Hoarseness lasting more than three weeks
The single most important trigger. NICE NG12 says persistent hoarseness over three weeks needs a two-week-wait ENT referral - especially in smokers and anyone over 60.
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Vocal cord nodules ("singer’s nodules")
Bilateral, symmetrical thickenings from voice overuse. Speech therapy is first-line; surgery only if refractory.
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Vocal cord polyp or cyst
A discrete lesion on one cord causing a rough, breathy voice - usually needs day-case micro-suspension excision.
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Reinke’s oedema (smoker-related)
Fluid-filled, floppy cords in long-term smokers, giving a deep, husky voice. Smoking must stop; decompression may follow.
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Vocal cord palsy
A breathy, weak voice from a paralysed cord. Requires CT neck and chest to look for a cause along the recurrent laryngeal nerve.
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Muscle tension dysphonia
A strained, tight voice with no lesion on the cords. Voice therapy is definitive; spasmodic dysphonia may need Botox.
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Reflux-related laryngitis
Posterior cord irritation and contact granuloma from acid. A PPI trial, voice therapy, and sometimes an injection.
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Red flags - same-day pathway
Neck lump, stridor, progressive difficulty swallowing, weight loss, ear pain, or blood in the sputum with hoarseness - urgent 2WW, not a routine booking.
Assessment and treatment
Surgery is not the only option - and never the first.
What each investigation and treatment on the table actually involves - and which fits which diagnosis.
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Flexible nasendoscopy (FNE)
A thin scope through the nose to see the vocal cords move - the single most important test for hoarseness and mandatory beyond three weeks.
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Videostroboscopy
Slow-motion imaging of the cord mucosal wave to pick up subtle lesions, scars and stiffness that FNE alone can miss.
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Speech and language therapy (SLT)
Voice therapy - GRBAS grading, VHI-30, laryngeal massage, resonant voice and SOVT exercises. First-line for nodules and muscle tension dysphonia.
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Micro-suspension laryngoscopy
Day-case GA. Cold-knife excision of nodules, polyps, cysts, Reinke’s decompression, papilloma debridement, or biopsy of a suspicious lesion.
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Injection medialisation
For a paralysed cord: hyaluronic acid (Restylane), Radiesse or collagen injected to bulk the cord back to midline - an office or day-case procedure.
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Type 1 thyroplasty (Isshiki)
A permanent implant (silastic or Gore-Tex) placed via a small neck incision to medialise a paralysed cord - for lasting palsy.
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Botox for spasmodic dysphonia
Small, targeted injections into the thyroarytenoid muscle roughly every three months - the definitive treatment for adductor spasmodic dysphonia.
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CT neck and chest (cord palsy work-up)
Rules out an apical lung tumour, thyroid mass, thoracic aortic aneurysm, or mediastinal disease along the recurrent laryngeal nerve.
Safety and expectations
What to expect - honestly.
Hoarseness assessment is safe and mostly office-based. What matters is not missing a red flag, and being honest about what voice therapy, surgery and lifestyle change can and cannot do.
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Any hoarseness over three weeks needs a scope
This is not optional. NICE NG12 puts persistent hoarseness on the two-week-wait pathway, especially in smokers and those over 60.
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Voice rest is first aid, not treatment
A few days of relative voice rest, hydration and no throat clearing helps acute laryngitis. It does not fix nodules, polyps or a palsy.
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Antibiotics are almost never the answer
Most acute laryngitis is viral. Antibiotics are reserved for a proven secondary bacterial infection - not routinely prescribed.
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Smoking is the biggest single risk
For Reinke’s oedema, for laryngeal cancer, and for anything that will not heal. Stopping is part of every treatment plan.
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Reflux worsens the picture
Laryngopharyngeal reflux irritates the posterior cords and drives contact granulomas. A PPI trial and evening habits matter.
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Post-operative voice rest is strict
After cord surgery, absolute voice rest for up to a week - including whispering - is what protects the result. SLT follows.
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A paralysed cord may recover
Idiopathic unilateral cord palsy is often watched for up to twelve months before permanent surgery, sometimes with a temporary injection meanwhile.
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HPV vaccination has a role
Recurrent respiratory papillomatosis is HPV-6/11 driven. Gardasil-9 is offered per Green Book indications alongside repeat debridement.
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Red flags
Stridor, a neck lump, weight loss, blood in the sputum, progressive swallowing trouble or ear pain with hoarseness - all mean urgent, not routine.
Reading your voice-clinic letter
Your letter in four parts. Read the last one first.
Whichever diagnosis it turns out to be, the letter the laryngologist sends you keeps to the same shape.
A quiet reminder
Laryngology language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the letter before your review, just ask.
- 01 Header
Presentation and duration
What the voice sounds like, how long it has been off, risk factors - smoking, alcohol, reflux, voice use, prior intubation, thyroid or chest surgery.
- 02 Examination
FNE and stroboscopy findings
What the cords looked like - normal, nodule, polyp, cyst, Reinke’s, granuloma, palsy - and what the mucosal wave showed on stroboscopy.
- 03 Findings
Neck, imaging and voice metrics
Neck lymph nodes and thyroid, CT/MRI findings if imaged, and the SLT metrics - GRBAS grade, VHI-30 score, acoustic analysis.
- 04 Impression
Plan and no-voice window if surgery
Read this first: SLT, day-case surgery, injection medialisation, or the two-week-wait cancer pathway - and the post-operative voice rest window if it applies.
Recognised by major UK insurers
Cover for hoarseness assessment, SLT and laryngeal surgery varies by insurer and by indication - usually funded when medically indicated.
Frequently asked
Everything we get asked about hoarseness.
Quick answers on when to worry, what the nasendoscope feels like, and what voice therapy and day-case surgery can and cannot do.
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How long is too long to be hoarse?
Three weeks. NICE NG12 in the UK triggers a two-week-wait suspected head-and-neck cancer referral for hoarseness lasting more than three weeks, especially in smokers and adults over 60. Do not wait it out beyond that window.
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What actually happens in a voice clinic?
A history, a neck and cranial-nerve examination, and a flexible nasendoscopy - a thin scope through the nose to look at the vocal cords moving. Stroboscopy is added for a detailed look at the mucosal wave. Speech and language therapy assessment is often done the same day.
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Does the nasal scope hurt?
No. A small amount of numbing spray goes in the nose, the scope is thin and flexible, and the whole thing takes a couple of minutes. You can talk, cough and swallow through it - that is the point.
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Can voice therapy alone fix my voice?
For vocal cord nodules and muscle tension dysphonia, voice therapy with a specialist SLT is the definitive treatment. For polyps, cysts and Reinke’s oedema, therapy helps but usually needs day-case surgery as well.
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What is a vocal cord palsy and why does it need a CT scan?
A palsy is a paralysed cord - often from injury to the recurrent laryngeal nerve, which runs from the neck into the chest and back up. A CT of neck and chest is standard to rule out a lung apex tumour, thyroid mass, aortic aneurysm or mediastinal cause.
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How much does private hoarseness assessment cost in the UK?
A one-stop ENT voice clinic with flexible nasendoscopy is roughly £300–£550. Stroboscopy adds £150–£300. Voice therapy sessions are £75–£150. Day-case micro-laryngoscopy typically runs £3,500–£8,000.
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Can hoarseness be cancer?
It can be. Persistent hoarseness is the commonest first symptom of laryngeal cancer, particularly in smokers and adults over 60. Early T1 laryngeal cancer has a five-year survival above 90%, which is exactly why the three-week rule matters.
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What treatments exist for a paralysed vocal cord?
Observation for up to twelve months in case it recovers, injection medialisation with a bulking agent such as hyaluronic acid (Restylane) or Radiesse as a temporary or bridging measure, and a permanent Isshiki type 1 thyroplasty implant if the palsy does not recover.
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