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Kerschner, J., Ridley, M., & Greene, J. (1995). Laryngeal Cryptococcus treatment with oral fluconazole. Archives of Otolaryngology – Head and Neck Surgery , 121 (10), 1193–1195. Klein, A., Tiu, C., & Lafreniere, D. (2005). Malignant mimickers: Chronic bacterial and fungal infections of the larynx. Journal of Voice , 19 (1), 151-157. Levitz, S. (1991). The ecology of Cryptococcus neoformans and the epidemiology of cryptococcosis. Clinical Infectious Diseases , 13 (6), 1163–1169. Maziarz, E., & Perfect, J. (2016). Cryptococcosis. Infectious Disease Clinics of North America , 30 (1), 179–206. doi:10.1016/j.idc.2015.10.006. Martin-Harris, B., Brodsky, M., Michel, Y., Castell, D., Schleicher, M., Sandidge, J., Maxwell, R., & Blair, J. (2008). MBS measurement tool of swallow impairment-MBSImp: Establishing a standard. Dysphagia , 22 (4), 392–405. Quintero, O., Trachuk, P., Lerner, M., Sarungbam, J., Pirofski, L., & Park, S. (2019). Risk factors of laryngeal cryptococcus: A case report. Medical Mycology Case Report , 24 , 82–85. doi: 10.1016/j.mmcr.2019.04.009 Rosenbek, J.C., Robbins, J.A., Roecker, E.B., Coyle, J.L., & Wood, J.L. (1996). A penetration-aspiration scale. Dysphagia , 11 , 93–8. Schwartz, S., Cohen, A., Dailey, S., Rosenfeld, R., Deutsch, E., Gillespie, M., ... & Patel, M. (2009). Clinical practice guideline: hoarseness (dysphonia). Otolaryngology – Head and Neck Surgery , 141 (3), 1–31. Stein, D., & Noordzij, P. (2013). Incidence of chronic laryngitis. Annals of Otology, Rhinology & Laryngology , 122 (12), 771–774. Subramanya, S., Jillwin, J., Rudramurthy, S., Rijal, K., Nayak, N., Chakrabarti, A., & Ghosh, A. (2018). Primary invasive laryngeal mycosis in an immunocompetent patient: A case report and clinic-epidemiological update. BMC Infectious Diseases , 18 (323), 1–8. https://doi.org/10.1186/ s12879-018-3219-1 Wertz, R., Rosenbek, J., McCullough, G., & Dinneen, C. (1999). Clinicians’ preferences and practices in conducting clinical/bedside and videofluoroscopic swallowing examinations in an adult, neurogenic population. American Journal of Speech-Language Pathology , 8 (2), 149–163. World Health Organization. (2001). International classification of functioning, disability and health: ICF . Geneva, Switzerland: Author. http://apps.who.int/iris/ handle/10665/42407. Worrall, D., Lerner, D., Naunheim, M., & Woo, P. (2019). Laryngeal cryptococcosis: An evolving rare clinical entity. Annals of Otology, Rhinology & Laryngology , 128 (5), 472- 479. doi:org/10.1177/0003489419826131. Rebecca Sexton is a speech-language pathologist at Redland Hospital. Sarah Fulton is a senior speech-language pathologist at Redland Hospital. Dr Bena Brown is an advanced speech- language pathologist, a principal allied health research fellow in cancer, and a senior lecturer and affiliate at the University of Queensland.

management of rare voice conditions may warrant development at a national professional standards level. Clinical implications • There are no evidence-based guidelines for the treatment of cryptococcal laryngitis, only cautious advice from infectious disease specialists around assessment and provision of anti-fungal therapy (Gordon et al., 2010). • There are no guidelines for speech pathologists to refer to regarding the assessment, treatment, management and prognosis of the presenting dysphonia and/or dysphagia. • Although cryptococcal laryngitis is an uncommon presentation, it is recommended speech-language pathologists remain vigilant and advocate for further assessment to exclude fungal infections as a cause for their patients presenting with persistent dysphonia. Conclusions Currently, there are no evidence-based guidelines for the treatment of cryptococcal laryngitis, only cautious advice from infectious disease specialists around assessment and provision of anti-fungal therapy. This case highlights the importance of considering fungal presentations in the differential diagnosis as a cause of persistent dysphonia. The authors advocate for ongoing collaboration within the multidisciplinary team (infectious disease specialists, ENT and speech-language pathologists) to accurately and effectively diagnose, manage and treat this patient population. References Bamba, H., Tatemoto, K., Inoue, M., Uno, T., & Hisa, Y. (2005). A case of vocal cord cyst with cryptococcal infection. Otolaryngology – Head and Neck Surgery , 133 (1), 150–152. Bergeron, M., Gagne, A., Cote, M., Chenevert, J., Dube, R., & Pelletier, R. (2015). Primary larynx cryptococcus neoformans infection: A distinctive clinical entity. Open Forum of Infectious Diseases , 2 (4), ofv160. doi:10.1093/ ofid/ofv160 Browning, D., Schwartz, D., & Jurado, R. (1992). Cryptococcosis of the larynx in a patient with AIDS: An unusual cause of fungal laryngitis. Southern Medical Journal , 85 (7), 762–764. Cohen, S., Dinan, M., Kim, J., & Roy, N. (2016). Otolaryngology utilization of speech-language pathology services for voice disorders. The Laryngoscope , 126 (4), 906–912. Delgado, A., Taguchi, M., Mikami, Y., Myiajy, M., Villares, M., & Moretti, M. (2005). Human cryptococcosis: Relationship of environmental and clinical strains of Cryptococcus neoformans var. neoformans from urban and rural areas. Mycopathologia , 159 (1), 7–11. Gordon, D., Stor, N., Yapa, H., Bova, R., & Marriott, D. (2010). Laryngeal cryptococcosis: Clinical presentation and treatment of a rare cause of hoarseness. Otolaryngology – Head and Neck Surgery , 142 (3), 7–9. Issa, I., & Thomas, J. (2018). Fungal laryngitis in immunocompetent patients: Risk factors, presentation and treatment. Scholarly Journal of Otolaryngology , 1 (3), 72–76. doi:10.32474/SJO.2018.01.000114 Isshiki N., Olamura M., Tanabe M., & Morimoto M. (1969). Differential diagnosis of hoarseness. Folia Phoniatr (Basel) , 21 (1), 9–23.

Correspondence to: Rebecca Sexton Speech Pathology Department, Redland Hospital Metro South Hospitals and Health Service, QLD Health Weippin St, Cleveland QLD 4163 phone: (07) 3488 4027 email: Rebecca.sexton@health.qld.gov.au

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