Evaluation of Dysphonic Patients by General Otolaryngologists
ABSTRACT OBJECTIVE: To investigate the instruments used by general otolaryngologists to visualize the larynx, assess the perception of the instruments' capabilities, and understand their comfort diagnosing specific etiologies of dysphonia. STUDY DESIGN: Cross-sectional survey. METHODS: One thousand randomly chosen general otolaryngologists from American Academy of Otolaryngology-Head & Neck Surgery were mailed a survey. RESULTS: The response rate was 27.8%. Mean years in practice were 19.5. Mirror and fiberoptic laryngoscopy were most commonly used. Approximately 84.1% used stroboscopy and 33.7% reported laryngoscopy could assess vibration. Respondents were more comfortable diagnosing conditions with obvious laryngeal structural abnormalities compared with those without, such as central neurologic disorders (P≤0.001). Approximately 46.5% were concerned about overdiagnosing laryngopharyngeal reflux (LPR). CONCLUSIONS: Although 84.1% of general otolaryngologists use stroboscopy, one-third may not appreciate the differences between stroboscopy and laryngoscopy. General otolaryngologists are less comfortable diagnosing voice disorders without obvious laryngeal structural abnormalities, and nearly 50% are concerned that they overdiagnose LPR.
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ABSTRACT: Objective: Videolaryngostroboscopy (VLS) is considered an important diagnostic tool in the evaluation of patients with laryngeal/voice disorders. We evaluated the frequency of, diagnoses associated with, and factors related to VLS use in the evaluation of outpatients with laryngeal/voice disorders. Study Design: Retrospective analysis of a large, national administrative U.S. claims database. Methods: Patients with a laryngeal disorder based on ICD-9-CM codes from January 1, 2004 to December 31, 2008, seen by an otolaryngologist were included. Patient age, gender, geographic region, laryngeal diagnosis, comorbid conditions, and whether laryngoscopy or VLS was performed during the outpatient otolaryngology visit were collected. Results: 168,444 unique patients saw an otolaryngologist for 272,112 outpatient visits. 6.2% of outpatient otolaryngology visits had a VLS performed. Patient age was related to VLS use with lower odds in the elderly (≥ 65 years of age) and those 0-17 years of age. Geographic variation was noted with higher odds of VLS use in urban versus rural areas and greater odds in the northeast versus the south. Laryngeal diagnosis was associated with VLS use with greatest odds for patients with multiple diagnoses, vocal fold paralysis and paresis followed by non-specific dysphonia and benign vocal fold/laryngeal pathology followed by acute and chronic laryngitis and laryngeal cancer. Patients with gastro-esophageal reflux (GER) had greater odds of VLS use than patients without GER. Conclusions: VLS was used in 6.2% of outpatient otolaryngology outpatient visits, and its use was influenced by multiple factors.The Laryngoscope 09/2014; 124(9). DOI:10.1002/lary.24688 · 2.03 Impact Factor
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ABSTRACT: Objectives/HypothesisControversial recommendations regarding the evaluation of dysphonia have been made in the absence of evidence related to clinical practice. This study aims to describe existing patterns of care for dysphonia to generate data for potential systemic improvement and provide a baseline for dysphonia recommendations.Study DesignRetrospective review.Methods Information regarding the current complaint, including duration of hoarseness; inciting factors; number and type of previous physicians seen; Voice Handicap Index-10; and details of prior evaluation, diagnosis, and treatment was collected from patient records.ResultsA total of 259 patients complaining of hoarseness were evaluated. Of those, 35.1% presented directly to subspecialty care, whereas 61% were previously evaluated by another otolaryngologist. Median times (in months) from symptom onset to evaluation were as follows: initial evaluation, 3.0; laryngoscopy, 3.0; stroboscopic exam, 5.8; subspecialty evaluation, 6.6. A total of 64.5% of patients had at least one incoming diagnosis; 45% of all incoming diagnoses were revised on re-evaluation. Diagnoses most commonly revised included “no abnormality,” edema or laryngopharyngeal reflux disease (LPR), infection or allergy, and muscle tension dysphonia (MTD) or behavioral disorders. Final diagnoses that most frequently differed from incoming diagnoses were paresis; MTD or behavioral disorders; malignancy; and sulcus, atrophy, or scar.Conclusions Patients received prompt laryngeal visualization. However, we observed high rates of diagnostic error. Initial diagnoses of LPR, edema, infection, and allergy appear to be particularly likely to be revised on further evaluation; and scar, sulcus, atrophy, and paresis are likely to be overlooked.Level of Evidence4. Laryngoscope, 2014The Laryngoscope 10/2014; 125(3). DOI:10.1002/lary.24955 · 2.03 Impact Factor
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ABSTRACT: Endoscopic sheaths covering the laryngoscope are advised to prevent cross contamination, but might hamper visualization as the most important tool in the diagnostic approach of laryngeal disease. We evaluated whether endoscopic sheaths change image quality and diagnostic accuracy of flexible distal chip laryngoscopy (DCL) and flexible fiberoptic laryngoscopy (FOL). Twelve healthy volunteers underwent a flexible laryngoscopy using a distal chip and a fiberoptic laryngoscope with and without endoscopic sheaths, and in this way 48 images were collected. To determine diagnostic accuracy, the 48 images were mixed with images of 40 patients. All images were randomly shown to four experts in the field of laryngology and head and neck oncology. Observers were asked to validate image quality, choose a diagnosis, and express their confidence level of that diagnosis. Image quality was validated better in DCL as compared to FOL (p < 0.05) both with or without endoscopic sheaths. Endoscopic sheaths worsened image quality in DCL (p < 0.05) but not in FOL. No differences were observed between DCL and FOL with or without endoscopic sheaths in diagnostic accuracy (79-89 %). Confidence levels (7.7-8.1) were comparable in DCL and FOL and not influenced by endoscopic sheaths. Image quality in DCL is superior to FOL, but significantly hampered by the use of endoscopic sheaths. In FOL the image quality is already low and not further diminished by endoscopic sheaths.Archives of Oto-Rhino-Laryngology 04/2014; DOI:10.1007/s00405-014-3058-7 · 1.61 Impact Factor