Management of Dysphonic Patients by Otolaryngologists

Duke Voice Care Center, Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Otolaryngology Head and Neck Surgery (Impact Factor: 2.02). 02/2012; 147(2):289-94. DOI: 10.1177/0194599812440780
Source: PubMed


To investigate common treatment approaches of general otolaryngologists for adult dysphonic patients without obvious laryngeal anatomic abnormalities.
Cross-sectional survey.
General otolaryngology community.
One thousand randomly chosen American Academy of Otolaryngology-Head and Neck Surgery general otolaryngologists were mailed a survey.
The response rate was 27.8%. Mean years in practice was 19.5. The most common treatments were proton pump inhibitor (PPI), referral to speech pathology, and stroboscopy. Muscle tension dysphonia, vocal fold nodules, and dysphonia of uncertain etiology were the most common reasons for voice therapy referral. Various forms of supraglottic compression and tender extralaryngeal muscles were identified as findings of muscle tension dysphonia. Response to once-daily PPI, laryngeal signs, and throat symptoms were the most common determinants for laryngopharyngeal reflux. When patients failed initial treatment, 58.2% refer for voice therapy, 46.9% obtain stroboscopy, and 33.3% extend or increase duration of PPI treatment.
Varied treatment approaches to adult dysphonic patients were identified. How practice patterns vary from best practice guidelines, affect patient outcome, and influence health care costs needs examination.

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    ABSTRACT: Objective To examine how primary care physicians (PCPs) and otolaryngologists use proton pump inhibitors (PPIs), antibiotics, antihistamines, oral and inhaled steroids, and histamine 2 antagonists in the treatment of laryngeal disorders.Study Design and SettingRetrospective analysis of data from a large, national administrative US claims database.Subjects and Methods Patients with laryngeal disorders based on ICD-9-CM codes from January 1, 2004, to December 31, 2008, seen as an outpatient by a PCP, otolaryngologist, or both and continuously enrolled for 12 months were included. Pharmacy claims, age, gender, geographic location, comorbid conditions, provider type, and laryngeal diagnosis were collected. Random-effects logistic regression and multinomial logistic regression analyses were performed.ResultsOf approximately 55 million individuals, 135,973 had a laryngeal diagnosis, 12 months post-index date follow-up, and an outpatient encounter with a PCP, otolaryngologist, or both. Acute laryngitis was one of the most common reasons PCPs prescribed each medication class. Nonspecific dysphonia was the most common reason otolaryngologists prescribed each medication class. Patients seen by a PCP had a higher odds ratio for receiving an antibiotic and antihistamine, and patients seen by an otolaryngologist had a greater odds ratio for receiving a PPI and inhaled steroids. After adjusting for other variables in the model, the probability that a patient seen by a PCP would receive an antibiotic was .55 and a PPI .13. If seeing an otolaryngologist, it was .44 and .22, respectively.Conclusion Differences exist regarding the prescribing patterns of PCPs and otolaryngologists in treating patients with laryngeal disorders.
    Otolaryngology Head and Neck Surgery 04/2013; 149(1). DOI:10.1177/0194599813485360 · 2.02 Impact Factor
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    ABSTRACT: OBJECTIVES/HYPOTHESIS: To examine how age, gender, comorbidity, geography, provider type, and laryngeal pathology influence the use of pharmacological treatment in managing patients with laryngeal disorders. STUDY DESIGN: Retrospective analysis of data from a large, nationally representative, administrative, US claims database. METHODS: Patients with a laryngeal disorder based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004 to December 31, 2008, seen as an outpatient by a primary care physician (PCP), otolaryngologist, or both and continuously enrolled for 12 months were included. Data regarding pharmacy claims, age, gender, geographic location, comorbid conditions, provider type, and laryngeal diagnosis were collected. To identify factors that influenced whether a patient received a medication or not, a logistic regression was performed. RESULTS: Of almost 55 million individuals in the database, 258,705 had a laryngeal diagnosis 12 months post-index date follow-up and an outpatient encounter with a PCP, otolaryngologist, or both. A total of 135,973 (52.6%) unique patients, mean age 47.4 years (22.2 standard deviation [SD]), with 61.9% female, received a medication, and 122,732 (47.4%), mean age 47.4 years (19.8 SD), with 65.8% female, did not. Higher odds ratios for medication treatment were associated with PCPs versus otolaryngologists, acute laryngitis, the South region, and patients with comorbid conditions. Variable prescription patterns were also observed for age and gender. CONCLUSIONS: Multiple factors are associated with the use of medical treatment for laryngeal disorders. LEVEL OF EVIDENCE: 2b. Laryngoscope, 2013.
    The Laryngoscope 07/2013; 123(7). DOI:10.1002/lary.24028 · 2.14 Impact Factor
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    ABSTRACT: Hoarseness is a symptom of laryngeal dysfunction, without an existing consensus regarding its appropriate evaluation. A survey of laryngeal specialists is proposed to establish expert opinion on the methodology for evaluation of hoarseness, and to identify divergence of opinion regarding appropriate management. Cross-sectional survey. A 13-item questionnaire was submitted electronically to the membership of the American Laryngological Association, the American Broncho-Esophagological Association, and the European Laryngological Society. Responses were collated anonymously and subjected to cross-tabulated data analysis. A total of 195 responses were included for review. The majority of respondents identified themselves as laryngologists/phoniatricians (54.9%). Two-thirds (64.1%) of the providers dedicated more than 25% of their practice to voice management, and 48.8% managed more than 10 dysphonic patients weekly. Most respondents defined hoarseness and dysphonia as symptoms and not diseases. The panel recommended a mandated time to laryngoscopy of 1 week to 1 month from the onset of symptoms for most acutely dysphonic patients, regardless of risk factors for malignancy, while it was not advised to defer laryngoscopy beyond 2 months of symptom persistence in any situation. A majority (96.2%) felt that an otolaryngologist ought to perform the initial laryngoscopy of a newly hoarse patient. This survey demonstrates an agreement to expedite specialized laryngeal visualization for cases of hoarseness not subsiding within 1 month, and exemplifies controversies stemming from a recently published clinical practice guideline. Ongoing research and practice evaluation will contribute to set forth improved standards of care and to appropriately counsel dysphonic patients. 5. Laryngoscope, 2013.
    The Laryngoscope 01/2014; 124(1). DOI:10.1002/lary.24178 · 2.14 Impact Factor
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