54 yo female hx of osteoarthritis of the left knee, anxiety, depression, tobacco use with complaints of voice hoarseness for 2 weeks. She has tried gargling with warm salt water, but it is not helping. Has not been sick with fever or chills. No sick contacts. No rhinorrhea or viral symptoms. Admits to current tobacco use and notes that her usual morning smokers cough has recently been worse. Denies hemoptysis but did note bloody sputum approximately three months ago which resolved. She is concerned that her voice change may be due to her tobacco use.