Does a specialist voice clinic change ENT clinic diagnosis?

Working Together to Find a Voice: Recommendations for Voice Healthcare Based on Expert-By-Experience and Practitioner Consensus

OBJECTIVES

Voice care services aim to provide effective and meaningful voice care. Current practice guidance recommends a multidisciplinary voice care approach, supported by the evidence-base and practitioner experience. However, unlike other areas of physical and mental health, current voice care guidance does not explicitly include the voices of experts-by-experience, meaning those who have lived experience of voice difficulties. The perspectives of those working within nonclinical voice professions, such as vocal coaches, are also often omitted. There is therefore a need for updated practice guidance which prioritizes expert-by-experience and nonclinical perspectives.

METHODS

Vocal Health Education hosted a consensus meeting in London, UK. The meeting was coproduced with experts-by-experience, and attendees included those with lived experience of voice difficulties and practitioners across a range of disciplines within voice care. The content of the meeting was synthesized into themes and associated recommendations were drafted and agreed to by all attendees.

RESULTS

The consensus statement offers practical advice to those working in voice care. Recommendations are offered for multidisciplinary and biopsychosocial voice care, with a focus on person-centered practice and the valuing of lived experience. Through discussion, consensus was reached regarding recommendations for voice care assessment and treatment, practitioner approach, psychosocial considerations, and service design. The need for greater expert-by-experience involvement, coproduction, and co-construction was emphasized throughout.

CONCLUSIONS

This report emphasizes the voices of those with lived experience. It highlights ways of updating or improving current care, with the aim of informing clinical practice as well as research and service development. The consensus statement is the first in voice care to include experts-by-experience at the center of its recommendations, underlining the need for more coproduced and co-constructed research and practice within voice healthcare.

Characteristics of a Treatment-seeking Population in a Private Practice Community Voice Clinic: An Epidemiologic Study

OBJECTIVE

The purpose of this study was to evaluate epidemiologic characteristics of a treatment-seeking population referred to a private practice community voice clinic.

STUDY DESIGN

This is a retrospective cohort study.

METHODS

Patient files representing evaluation referrals over a 28-month period were reviewed. Variables tabulated from records included disorder diagnosis, age, gender, perceptual voice quality ratings, and self-perceived voice handicap at initial evaluation. Descriptive statistics were used to evaluate the diagnosis category and demographic patterns. Parametric statistics were applied to quantitative clinical measurements to test the effect of voice disorder category on perceptual voice quality ratings and self-perceived voice handicap.

RESULTS

A total of 216 consecutive patient files were reviewed. Collectively, the most common disorder diagnosis was "other," consisting of a varied cluster of etiologies, including reflux laryngitis, chronic cough, bilateral paralysis or paresis, leukoplakia, and polypoid degeneration. The most common diagnosis in women was midmembranous lesions, and that in men was the "other" category followed by atrophy and bowing associated with presbylaryngis. The greatest severity and handicap measures were found in patients with unilateral paralysis.

CONCLUSIONS

Collectively, the demographic patterns reported in this study align with those from specialty voice clinics housed in academic medical centers and community voice clinics led by laryngologists and general otolaryngologists. Translating these findings to professional practice, the data support the notion that speech-language pathologists specializing as voice therapists who seek to establish private practice clinics should possess competencies in the knowledge and skills required to serve treatment-seeking populations with a wide variety of voice impairments.

Change in diagnosis and treatment following specialty voice evaluation: A national database analysis

OBJECTIVE

We evaluated the association between specialty voice evaluation and changes in laryngeal diagnosis and treatment in patients with laryngeal/voice disorders.

STUDY DESIGN

Retrospective analysis of a large, national administrative U.S. claims database.

METHODS

Patients included were identified with a laryngeal disorder based on International Classification of Diseases, Ninth Revision, Clinical Modification codes, from January 1, 2004, to December 31, 2008, and had been seen by an otolaryngologist as an outpatient and had a specialty voice evaluation designated by videolaryngostroboscopy (VLS) within 90 days of the last laryngoscopy. Patient diagnosis at the last laryngoscopy visit and the subsequent initial VLS visit were collected. Specific treatment modalities were tabulated for the 30-day period after the last laryngoscopy and for 30 days after the VLS.

RESULTS

A total of 168,444 unique patients saw an otolaryngologist for 273,616 outpatient visits. Of those, 6.1% had a VLS performed, of which 4,000 (23.8%) occurred within 90 days of the last laryngoscopy, with a median interval of 30 days (interquartile range 15-50 days). Half of the patient visits had a change in laryngeal diagnosis. Changes in use of antibiotics, proton pump inhibitors, voice therapy, and surgical intervention were seen after specialty voice evaluation.

CONCLUSIONS

Specialty voice evaluation was associated with changes in laryngeal diagnosis and treatment. Further study is needed to assess the impact on health care costs and patient outcomes.