Role of rhinitis in laryngitis: another dimension of the unified airway.

OBJECTIVES: We evaluated the prevalence of dysphonia and secondary laryngeal symptoms among patients with allergic rhinitis (AR), nonallergic rhinitis (NAR), and no rhinitis symptoms (controls). METHODS: Patients with rhinitis symptoms with positive and negative allergy tests were recruited from allergy clinics, and patients without rhinitis symptoms were recruited from an orthopedic clinic. All groups completed the Voice-Related Quality of Life survey (VRQOL),the mini-Rhinoconjunctivitis Quality of Life Questionnaire (mini-RQLQ), and the Reflux Symptom Index (RSI). RESULTS: Completing the study were 134 patients with AR, 54 patients with NAR, and 62 controls. Both AR and NAR patients had an increased prevalence of dysphonia compared to controls (32.8% and 26.9% versus 8.1%, respectively; p = 0.001). When we controlled for confounding variables such as asthma, inhaled steroid use, and gastroesophageal reflux, patients with either AR or NAR had higher odds of dysphonia (odds ratio, 4.22; 95% confidence interval, 1.03 to 17.32). Patients with worse mini-RQLQ scores had lower VRQOL scores and higher RSI scores (Spearman correlation of -0.47 and p < 0.001 and Spearman correlation of 0.6 and p <0.001, respectively). CONCLUSIONS: Patients with rhinitis (AR or NAR) had a higher prevalence of dysphonia than did controls. Patients with worse rhinitis symptoms had worse voice-related quality of life and more severe chronic laryngeal symptoms.

Primary care approach to dysphonia.

OBJECTIVE: To understand how primary care physicians manage patients with dysphonia and the barriers they face when evaluating patients for voice problems. STUDY DESIGN: Cross-sectional survey. SETTING: Primary care community. SUBJECTS AND METHODS: A total of 933 internal and family medicine physicians were randomly selected from a database of physicians in a referral basin of a tertiary care medical center and mailed a questionnaire. Questions concerned physician comfort level in recognizing an abnormal voice, their view of the quality of life impact of dysphonia, frequency of evaluating patients for voice problems, barriers to the evaluation of voice problems, reasons for referral, and common treatments prior to referral. RESULTS: A total of 271 physicians responded, for a response rate of 29.0 percent. Of those who responded, 36.5 percent routinely evaluate their patients for voice problems. Reasons for not evaluating patients for voice problems were patients not complaining about hoarseness, more pressing issues, not feeling comfortable assessing patients for voice problems, and time constraints. Chronic voice changes and not being able to understand patients' speech were the most common reasons for referral. Reflux and allergy treatment were common treatment modalities prior to referral. A total of 67.5 percent of respondents were interested in learning more about voice problems. CONCLUSION: Primary care physicians face limitations with respect to evaluating patients for voice problems. Otolaryngologists must continue outreach efforts and collaboration with primary care colleagues in order to enhance the screening for voice problems.

Coprevalence and impact of dysphonia and hearing loss in the elderly.

OBJECTIVES/HYPOTHESIS: To determine the coprevalence of voice problems and hearing loss in the elderly, to assess whether hearing loss is a risk factor for dysphonia, and to evaluate the quality-of-life impact of dysphonia and hearing loss among the elderly. STUDY DESIGN: Cross-sectional study of independent living residents in two retirement communities. METHODS: Main outcome measures include prevalence of dysphonia and hearing loss, Voice Related Quality of Life (VRQOL), Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S), and the Center for Epidemiologic Studies Depression (CES-D) scale. Relationships between continuous variables were analyzed with Spearman correlation, between categorical variables with chi-square, and between categorical and continuous variable with analysis of variance (ANOVA) on ranks. RESULTS: A total of 248 residents responded with a mean age of 82.4 years. Of those, 19.8% had dysphonia, 50.0% had hearing loss, and 10.5% had both. Respondents with hearing loss were more likely to have dysphonia than those without hearing loss (odds ratio = 2.31, 95% confidence interval, 1.19-4.47). Worse VRQOL scores were associated with more impairment on the HHIE-S (Spearman correlation = -0.36, P < .001). Respondents with both dysphonia and hearing loss had greater depression scores than those with neither symptom (median CES-D score 13 vs. 8, P = .03, ANOVA on ranks, Dunn's method, P < .05). CONCLUSIONS: Voice problems and hearing loss are common in the elderly, adversely impact quality of life, and require simultaneous management.

Impact of voice and swallowing problems in the elderly.

OBJECTIVES: 1) Evaluate the prevalence and quality-of-life impact of voice and swallowing problems in the elderly; 2) determine treatment trends and barriers to treatment. STUDY DESIGN: Cross-sectional study of independent-living residents in two retirement communities. Prevalence of dysphonia and dysphagia, voice-related quality of life (VRQOL), 7-point Likert scale of dysphagia severity, Center for Epidemiologic Studies Depression (CES-D) scale, and barriers to treatment were collected. Spearman correlation and ANOVA statistics were performed. RESULTS: A total of 248 residents responded with a mean age of 82.4 years; 19.8 percent had dysphonia, 13.7 percent dysphagia, and 6 percent both. Respondents with more severe swallowing difficulty had greater impairment on the VRQOL (P = 0.04, Spearman correlation = -0.4). Respondents with both dysphonia and dysphagia had greater depression scores than those with neither symptom (mean CES-D score 15.5 vs 9.9, P = 0.009, ANOVA, P < 0.05, Bonferroni t test). Only 22.4 percent and 20.6 percent had sought treatment for dysphonia and dysphagia, respectively. Being unaware of treatment options and viewing voice and swallowing trouble as a normal part of aging were the most common reasons for not seeking treatment. CONCLUSIONS: Voice and swallowing problems are common in the elderly, but they are not realizing potential treatment benefits.

Improved outcomes in patients with head and neck cancer using a standardized care protocol for postoperative alcohol withdrawal.

OBJECTIVE: To show clinical benefit in the main outcome measures by the use of a standardized protocol for identification, characterization, and treatment of alcohol withdrawal syndrome (AWS) in postoperative patients with head and neck cancer. DESIGN: Prospective cohort study with a retrospective cohort control. SETTING: Tertiary care university. PATIENTS: A total of 26 consecutive postoperative patients with AWS were selected from among 652 patients with head and neck cancer to be enrolled in the protocol from March 2003 through March 2005. Controls consisted of 14 of 981 consecutive patients with AWS from March 2000 through December 2002. INTERVENTION: Application of a standardized care protocol. MAIN OUTCOME MEASURES: Sensitivity and specificity of preoperative screening for AWS risk, predictability of outcomes, length of stay, transfers to the intensive care unit (ICU), AWS symptoms, postoperative morbidity and mortality, doses of pharmacotherapy required, and charges. RESULTS: Protocol patients demonstrated significantly fewer AWS-related ICU transfers and less delirium and violence than preprotocol patients. Mortality, wound complications, hospital charges, and doses of benzodiazepines, clonidine, and haloperidol were not significantly different between these 2 groups. Preoperative medical history correlated poorly with AWS outcomes. Screening was 87.5% sensitive and 99.7% specific. Late enrollees to the protocol (false-negative screening results) showed many significantly worse outcomes than immediate enrollees. CONCLUSION: Use of the standardized AWS symptom-triggered protocol decreased delirium, violence, and AWS-related ICU transfers without significantly increasing hospital charges.