Persistent hoarseness: an aggressive approach for early detection of laryngeal cancer.

Persistent hoarseness in a patient should always alert the physician to the possibility of laryngeal carcinoma. Prompt visualization of the larynx is essential, particularly in high-risk patients over 40 years of age without a history of upper respiratory infection. Mirror examination (indirect laryngoscopy) is the usual initial diagnostic procedure, although Hopkins' rod telescope and the fiberoptic laryngoscope may provide more adequate visualization. Direct laryngoscopy and biopsy allow definitive diagnosis.