Voice Hoarseness After Dialysis in ESRD Patients

Diagnostic Considerations

The American Academy of Otolaryngology-Head and Neck Surgery recommends performing laryngoscopy within days if patients have a history of tobacco or alcohol use, concomitant neck mass or lymphadenopathy, hemoptysis, dysphagia, odynophagia, or otalgia, unexplained weight loss or night sweats, progressive worsening rather than transient post-dialysis pattern, or recent neck, chest, or cardiac surgery 1, 2, 3, 4
All ESRD patients with hoarseness persisting beyond 4 weeks require laryngoscopy, regardless of the temporal relationship to dialysis, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery 1, 3

The American Academy of Otolaryngology-Head and Neck Surgery suggests documenting temporal pattern, onset characteristics, voice quality changes, intradialytic symptoms, and medication review, including inhaled corticosteroids, ACE inhibitors, antihistamines, and anticholinergics 1, 4, 5

The American Academy of Otolaryngology-Head and Neck Surgery recommends optimizing dialysis parameters to minimize intradialytic hypotension, including slower ultrafiltration rates 4, and lower dialysate temperature, as well as voice hygiene counseling, including adequate hydration and voice rest 3
The American Academy of Otolaryngology-Head and Neck Surgery advises against prescribing empiric antibiotics, corticosteroids, or anti-reflux medications without laryngoscopic visualization 3, 4

The American Academy of Otolaryngology-Head and Neck Surgery notes that voice disorders in dialysis patients can significantly impact social functioning, occupational performance, and psychological well-being 2, 3, 4