What are the recommended referral criteria for patients requiring laryngoscopy after initial assessment?

Recommended referral criteria for laryngoscopy following initial assessment:

• Consider referral for laryngoscopy in adults with isolated and unexplained persistent dysphonia (a quiet, hoarse or wobbly voice) after excluding hoarseness caused by structural abnormality or malignancy by ear, nose and throat examination.
• Persistent dysphonia may also be a presenting symptom of neurological conditions such as Parkinson's disease, so referral should consider this differential diagnosis.

These criteria highlight that laryngoscopy is indicated primarily when persistent voice changes remain unexplained after initial ENT assessment excludes other causes.

References: This is based on the recommendation to consider referral for laryngeal dystonia assessment if structural or malignant causes are excluded ².