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.
    Full-text · Article · Apr 2013 · Otolaryngology Head and Neck Surgery
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    ABSTRACT: To examine how age, gender, comorbidity, geography, provider type, and laryngeal pathology influence the use of pharmacological treatment in managing patients with laryngeal disorders. Retrospective analysis of data from a large, nationally representative, administrative, US claims database. 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. 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. Multiple factors are associated with the use of medical treatment for laryngeal disorders. 2b. Laryngoscope, 2013
    Full-text · Article · Jul 2013 · The Laryngoscope
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