Otolaryngology utilization of speech‐language pathology services for voice disorders

Abstract

2C.

Pharmacologic management of voice disorders by general medicine providers and otolaryngologists

“…Although stroboscopy was used in only 17.4% of our patient cohort, and even less frequently (i.e., 6.2%) within a larger cohort of outpatient otolaryngology visits for laryngeal/voice disorders, evaluation with stroboscopy or in a multidisciplinary fashion with speech-language pathology (SLP) may impact the diagnosis and related treatment of laryngeal/voice-disordered patients. 20 Despite low and varied inter- and intrarater reliability for diagnosing laryngopharyngeal reflux (LPR) via laryngeal examination, empiric treatment with PPIs has increased among otolaryngologists. 21,22 With otolaryngologists reporting being less comfortable when diagnosing laryngeal/voice disorders in the absence of frank structural or mobility abnormalities as compared to vocal fold lesions and vocal fold paralysis, patients may receive inappropriate medications based on a presumed diagnosis, comorbid condition, or concomitant illness.…”

“…Only 11.8% of our patient cohort (and 4.9% of a larger cohort of laryngeal/voice-disordered patients) with otolaryngology evaluation received SLP evaluation/treatment. 20 Voice stimulability testing administered by an SLP has an important role and can shed light on the nature of the patient’s voice problem and the patient’s potential for improvement with voice therapy as the primary modality. 30,31 Even after controlling for the use of stroboscopy, as compared with otolaryngology evaluation without SLP, laryngeal/voice-disordered patients who also had SLP evaluation had an 18% greater odds of having a change in laryngeal diagnosis and were more likely to attend voice therapy.…”

“…30,31 Even after controlling for the use of stroboscopy, as compared with otolaryngology evaluation without SLP, laryngeal/voice-disordered patients who also had SLP evaluation had an 18% greater odds of having a change in laryngeal diagnosis and were more likely to attend voice therapy. 20 Further evaluation is needed to examine the impact of multidisciplinary evaluation of laryngeal/voice-disordered patients and the impact on healthcare utilization, especially subsequent pharmacologic treatment. This may be especially germane for patients 1) who already have previously seen a GMP and failed prior medication trials, and/or 2) do not have obvious structural or mobility abnormalities of the vocal folds on laryngoscopy sufficient to account for the degree of dysphonia observed.…”

Predictors of Six-month Change in the Voice Handicap Index in a Treatment-seeking Population

“…Two recent studies have highlighted the importance of the ENT and SLP multidisciplinary approach, with results demonstrating greater use of videostroboscopy, increased likelihood of subsequent voice therapy, better therapy attendance, improved therapy outcomes and fewer lost billable hours due to patient no-shows. 54,55 Unfortunately, it is estimated that less than five percent of outpatients with voice or other laryngeal disorders seen by an ENT also have SLP evaluation. 54 …”

“…54,55 Unfortunately, it is estimated that less than five percent of outpatients with voice or other laryngeal disorders seen by an ENT also have SLP evaluation. 54 …”