Hoarseness preceded by a sore throat or accompanied by flu-like symptoms such as cough, low-grade fever, or coryza is likely due to viral laryngitis. Epiglottitis must also be considered if the patient appears ill, has a high fever, has difficulty swallowing or is drooling, has no associated flu-like symptoms, or reports difficulty breathing. A history of chronic hoarseness must be considered suggestive of a structural or neoplastic cause, directly involving either the larynx or the recurrent laryngeal nerve. Hypothyroidism should be considered in patients with chronic hoarseness and other historical evidence of thyroid hormone deficiency.