Persistent hoarseness, as a symptom of laryngeal cancer, is one of the most frequent referrals made in the "urgent suspicion of cancer" (USOC) category in Scotland. This is equivalent to the "2-week wait" category in England. The Scottish Referral Guidelines (SRG) make no exclusions on age of patients with hoarseness, unlike the NICE guidelines 1 which stipulate that referrals are only received for patients 45 years or older. Hoarseness as a presentation of laryngeal cancer is important. Most head and neck cancers present in advanced stages, yet hoarseness as a presenting symptom can be a marker of early-stage disease. 2 The vast majority of patients referred with hoarseness can be safely reassured and discharge following examination and while much is currently published on the risk of having laryngeal cancer, 3,4 examining other factors in relation to laryngeal health and focusing on the lower risk benign group is an understudied area.There are around 2500 cases of laryngeal cancer diagnosed in the UK each year. 5 Laryngeal cancer overwhelmingly presents in older patients-3 quarters of all diagnoses are in patients aged over 60 years. 2 It is well documented that tobacco and alcohol are the main causative factors for larynx cancer. Compared to oropharyngeal cancer, the human papilloma virus does not appear to be a major cause. 6 Laryngeal cancer is more common in males than females (a ratio of 4.5 men to 1 woman) and is more commonly diagnosed in patients of a lower socioeconomic group. 7