Bamboo Nodes as an Autoimmune Disease Laryngeal Manifestation. Case Series.

INTRODUCTION: Bamboo nodes are transverse creamy-yellow subepithelial nodes in the vocal folds (VF) midpoint, usually bilateral, resembling a bamboo stem. They appear almost exclusively in females, and are associated with underlying autoimmune diseases. CASE SUMMARY: Six female patients, 45.5 years median age, with underlying autoimmune diseases, consulted due to dysphonia. The laryngeal stroboscopy showed bilateral VF bamboo nodes in four patients, and unilateral in the remaining two. VF mobility was normal in all patients, while the mucosal wave was impaired in four of them. Treatment with speech therapy and proton pump inhibitors was indicated. All the patients were referred for rheumatologic evaluation and immunosuppressive treatment optimization. Follow-up in five patients showed vocal function self-perception and GRBAS scores improvement. DISCUSSION: VF bamboo nodes are an infrequent cause for dysphonia, associated with phonotrauma and autoimmune diseases. Speech therapy and a rheumatologic workup must be indicated, for immunosuppressive treatment enhancement.

Safety of office-based flexible endoscopic procedures of the pharynx and larynx under topical anesthesia.

INTRODUCTION: Flexible endoscopic procedures (FEP) using a working channel allowed otolaryngologists to perform more procedures on the pharynx and the larynx under local anesthesia. The purpose of this work is to demonstrate the feasibility and safety of this technique by studying the adverse effects of this practice in an office-based setting. METHODS: This is a monocentric retrospective cohort study. We searched the database using the French procedural code for FEP performed in an outpatient setting between January 2005 and December 2020. Data regarding the patient's characteristics, indications, and periprocedural complications were extracted. RESULTS: In total, we included 231 patients with a total of 308 FEP: 36% biopsy, 20% hyaluronic acid injection (including 3.5% at the level of the cavum), 20% injection of other substances (in descending order: botulinum toxin, cidofovir, physiological serum, cortisone), 20% exploration for an occult tumor, 3% samples for microbiological analysis, 1% other procedures. Of the 308 FEP included in this study, 24 patients (10.3%) had complications corresponding to 7.8% of the procedures performed. During the procedures, reported complications include minor laryngeal bleeding (n = 5), vasovagal syncope (n = 5), laryngospasm (n = 1) or nausea (n = 3), dysphagia (n = 3), and voice disorders (n = 3). Post-procedural complications were hypertensive crisis (n = 1), asthma attack (n = 1), pneumonia (n = 1), laryngitis (n = 1). Using the Clavien-Dindo classification system, these complications could be defined as grade I (laryngeal bleeding, vasovagal syncope, laryngospasm, dysphagia, nausea, voice disorders, and laryngitis) and grade II (hypertensive crisis, asthma attack, pneumonia) in 9.1% and 1.2% of cases, respectively. Most of these complications were self-limiting, while asthma attacks, pneumonia, laryngitis, and voice disorders required a medical intervention. All complications were managed without sequelae. There was no serious complication grade (no grade III, IV or V). CONCLUSIONS: FEP, which is now well standardized in our institution, makes it possible to carry out a wide range of interventions with little morbidity. These results are in line with those of literature but this technique remains out of nomenclature in France. Our experience led to the development of an evidence-based standard of care that can serve as a framework for practitioners on a nationwide level, while the work to establish official guidelines by the French society of phoniatrics and laryngology is in progress.

Laryngeal disorders in people living with HIV.

OBJECTIVES: Several studies have shown that HIV infected individuals are at higher risk compared to the general population of developing non-AIDS defining conditions such as some types of cancer, kidney disease, liver disease and others. In this case-control study, we compared the incidence of laryngeal disorders between a treatment-seeking HIV-positive population and uninfected controls. We aimed to investigate whether there are any laryngeal disorders that are overrepresented in HIV-positive individuals. METHODS: This was a case-control study based on retrospective chart review, comparing the incidence of laryngeal, airway, and swallowing disorders in sixty-nine HIV positive individuals and 4178 HIV negative controls treated between January 1, 2016 and December 31, 2017, at the Johns Hopkins Voice Center. RESULTS: A majority of HIV-infected patients (59.4%) had at least one diagnosis belonging to the Vocal cord pathology category compared to 48.2% of controls (OR 1.57, p = 0.065). Compared to the entire treatment-seeking population, HIV patients were more likely to present with laryngeal cancer (15.9% vs. 3.4% in controls, OR 5.43, p < 0.001) and chronic laryngitis (17.4% vs. 4.2%, OR 4.79, p < 0.001). Fungal and ulcerative laryngitis were also overrepresented in HIV-positive individuals (OR 9.45, p < 0.001 and 6.29, p < 0.001, respectively). None of the diagnoses categorized as functional voice disorders, swallowing, or airway problems showed a significant difference between groups. Laryngeal papillomatosis, which is an HPV-dependent disease, had similar prevalence in both groups. CONCLUSIONS: Treatment-seeking HIV-positive patients presenting to a laryngology clinic suffer significantly more often from laryngeal squamous cell carcinoma as well as chronic, fungal, and ulcerative laryngitis compared to HIV-negative individuals. LEVEL OF EVIDENCE: 4.

Glottal Closure in Women with No Voice Complaints or Laryngeal Disorders

Introduction: The understanding of normal vocal production is essential to guide any voice professional as it is fundamental to understand the effects of the posterior glottal gap on the vocal quality. Objective: The aim of the present study was to verify the association between glottic closure, acoustic parameters, and some characteristics of the videolaryngostroboscopy of young women without vocal complaints nor laryngeal disorders. Methods: This is a cross-sectional study with 56 women between 20 and 30 years old who underwent videolaryngostroboscopy. The acoustic parameters of the vowel /a:/ were analyzed using the Praat software, Release 4.6.10 (Paul Boersman and David Weenik, Amsterdam, Netherlands). Statistical Analysis: The chi-squared, Fischer, and Kruskall-Wallis tests were applied, with 5% significance. Results: Significant occurrence of posterior glottal gap (85.71%, p < 0.001), of normal vocal folds vibration amplitude (82.14%, p < 0.001), and of absence of significant constriction of the laryngeal vestibule (98.21%, p < 0.001); no significant association of the glottic closure with the vocal acoustic parameters; no significant association of glottic closure, vocal folds vibration amplitude, and constriction of the laryngeal vestibule. Conclusion: There was a predominance of posterior glottal gap, normal vocal folds vibration amplitude, and absence of laryngeal vestibule constriction, and no relation with the acoustic parameters, suggesting that the posterior glottal gap did not generate impact on the vocal production of the young adult women studied (AU)

Glottal Closure in Women with No Voice Complaints or Laryngeal Disorders.

Introduction The understanding of normal vocal production is essential to guide any voice professional as it is fundamental to understand the effects of the posterior glottal gap on the vocal quality. Objective The aim of the present study was to verify the association between glottic closure, acoustic parameters, and some characteristics of the videolaryngostroboscopy of young women without vocal complaints nor laryngeal disorders. Methods This is a cross-sectional study with 56 women between 20 and 30 years old who underwent videolaryngostroboscopy. The acoustic parameters of the vowel /a:/ were analyzed using the Praat software, Release 4.6.10 (Paul Boersman and David Weenik, Amsterdam, Netherlands). Statistical Analysis The chi-squared, Fischer, and Kruskall-Wallis tests were applied, with 5% significance. Results Significant occurrence of posterior glottal gap (85.71%, p < 0.001), of normal vocal folds vibration amplitude (82.14%, p < 0.001), and of absence of significant constriction of the laryngeal vestibule (98.21%, p < 0.001); no significant association of the glottic closure with the vocal acoustic parameters; no significant association of glottic closure, vocal folds vibration amplitude, and constriction of the laryngeal vestibule. Conclusion There was a predominance of posterior glottal gap, normal vocal folds vibration amplitude, and absence of laryngeal vestibule constriction, and no relation with the acoustic parameters, suggesting that the posterior glottal gap did not generate impact on the vocal production of the young adult women studied.

Associations between Community-Acquired Pneumonia and Proton Pump Inhibitors in the Laryngeal/Voice-Disordered Population.

OBJECTIVES: To examine the relationship between community-acquired pneumonia (CAP) and proton pump inhibitor (PPI) treatment among patients with laryngeal/voice disorders. STUDY DESIGN: Retrospective cohort analysis. SETTING: Large national administrative US claims database. SUBJECTS AND METHODS: Patients were included if they were ≥18 years old; had outpatient treatment for a laryngeal/voice disorder from January 1, 2010, to December 31, 2014 (per International Classification of Diseases, Ninth Revision, Clinical Modification codes); had 12 months of continuous enrollment prior to the index date (ie, first diagnosis of laryngeal/voice disorder); had no preindex diagnosis of CAP; and had prescription claims captured from 1 year preindex to end of follow-up. Patient demographics, comorbid conditions, index laryngeal diagnosis, number of unique preindex patient encounters, and CAP diagnoses during the postindex 3 years were collected. Two models-a time-dependent Cox regression model and a propensity score-based approach with a marginal structural model-were separately performed for patients with and without pre-index date PPI prescriptions. RESULTS: A total of 392,355 unique patients met inclusion criteria; 188,128 (47.9%) had a PPI prescription. The 3-year absolute risk for CAP was 4.0% and 5.3% among patients without and with preindex PPI use, respectively. For patients without and with pre-index date PPI use, the CAP occurrence for a person who had already received a PPI is 30% to 50% higher, respectively, than for a person who had not yet had a PPI but may receive one later. CONCLUSIONS: Patients without and with pre-index date PPI use experienced a roughly 30% to 50% increased likelihood of CAP, respectively, as compared with patients who had not had PPI prescriptions.

Pharmacologic management of voice disorders by general medicine providers and otolaryngologists.

OBJECTIVES: 1) To compare laryngeal diagnoses from general medical providers (GMP) to otolaryngologists following GMP-based medication trial, and 2) to evaluate associations between GMP medication trials and pharmacologic treatment by otolaryngologists. METHODS: Retrospective cohort analysis using large, national administrative U.S. claims database. Patients with laryngeal/voice disorders as per the International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2010, to December 31, 2012, seen by a GMP and then an otolaryngologist between 2 weeks to 3 months after the GMP visit, were included. Patient demographics, comorbid conditions, medication use, and initial GMP and otolaryngology laryngeal diagnoses were collected. Logistic regression was performed to evaluate the association between GMP and otolaryngologist medication trials. RESULTS: A total of 12,475 unique laryngeal/voice-disordered patients met inclusion criteria. At the initial GMP visit, 15.3% received an antibiotic, 14.0% a proton pump inhibitor (PPI), and 7.7% an oral steroid. After the otolaryngology visit, increased diagnoses of vocal fold paralysis/paresis, benign vocal fold/laryngeal pathology, chronic laryngitis, and multiple diagnoses occurred. The adjusted odds for an otolaryngologist prescribing an antibiotic, PPI, or oral steroid, respectively, given that a GMP prescribed an antibiotic, PPI, or oral steroid, was roughly two to three times higher that of a GMP not prescribing the given medication. CONCLUSION: Patients with structural and neuromuscular laryngeal disorders were treated with medications by GMPs, and similar mediations often were repeated after otolaryngology evaluation. These findings suggest potential areas of unnecessary pharmacologic treatment of laryngeal/voice-disordered patients. LEVEL OF EVIDENCE: 2b. Laryngoscope, 128:682-689, 2018.

Increased respiratory neural drive and work of breathing in exercise-induced laryngeal obstruction.

Exercise-induced laryngeal obstruction (EILO), a phenomenon in which the larynx closes inappropriately during physical activity, is a prevalent cause of exertional dyspnea in young individuals. The physiological ventilatory impact of EILO and its relationship to dyspnea are poorly understood. The objective of this study was to evaluate exercise-related changes in laryngeal aperture on ventilation, pulmonary mechanics, and respiratory neural drive. We prospectively evaluated 12 subjects (6 with EILO and 6 healthy age- and gender-matched controls). Subjects underwent baseline spirometry and a symptom-limited incremental exercise test with simultaneous and synchronized recording of endoscopic video and gastric, esophageal, and transdiaphragmatic pressures, diaphragm electromyography, and respiratory airflow. The EILO and control groups had similar peak work rates and minute ventilation (V̇e) (work rate: 227 ± 35 vs. 237 ± 35 W; V̇e: 103 ± 20 vs. 98 ± 23 l/min; P > 0.05). At submaximal work rates (140-240 W), subjects with EILO demonstrated increased work of breathing ( P < 0.05) and respiratory neural drive ( P < 0.05), developing in close temporal association with onset of endoscopic evidence of laryngeal closure ( P < 0.05). Unexpectedly, a ventilatory increase ( P < 0.05), driven by augmented tidal volume ( P < 0.05), was seen in subjects with EILO before the onset of laryngeal closure; there were however no differences in dyspnea intensity between groups. Using simultaneous measurements of respiratory mechanics and diaphragm electromyography with endoscopic video, we demonstrate, for the first time, increased work of breathing and respiratory neural drive in association with the development of EILO. Future detailed investigations are now needed to understand the role of upper airway closure in causing exertional dyspnea and exercise limitation. NEW & NOTEWORTHY Exercise-induced laryngeal obstruction is a prevalent cause of exertional dyspnea in young individuals; yet, how laryngeal closure affects breathing is unknown. In this study we synchronized endoscopic video with respiratory physiological measurements, thus providing the first detailed commensurate assessment of respiratory mechanics and neural drive in relation to laryngeal closure. Laryngeal closure was associated with increased work of breathing and respiratory neural drive preceded by an augmented tidal volume and a rise in minute ventilation.

Identifying Occupations at Risk for Laryngeal Disorders Requiring Specialty Voice Care.

Objective To identify occupational groups' use of specialty voice clinic evaluation. Study Design Retrospective cohort study. Setting Tertiary subspecialty clinic. Subjects and Methods We analyzed data collected on patients presenting to the Massachusetts Eye and Ear Infirmary Voice and Speech Laboratory over a 20-year period (1993-2013). The relative risk (RR) and 99% confidence interval (CI) of presentation were calculated for each occupational category in the greater Boston population using year-matched data from the Bureau of Labor Statistics (BLS). Results The records of 12,120 new patients were reviewed. Using year- and occupation-matched BLS data from 2005 to 2013, 2726 patients were included in the cohort analysis. Several occupations had significantly higher risk of presentation. These included arts and entertainment (RR 4.98, CI 4.18-5.95), law (RR 3.24, CI 2.48-4.23), education (RR 3.08, CI 2.70-3.52), and social services (RR 2.07, CI 1.57-2.73). In contrast, many occupations had significantly reduced risk of presentation for laryngological disorders, for example, maintenance (RR 0.25, CI 0.15-0.42), food preparation (RR 0.35, CI 0.26-0.48), and administrative support (RR 0.49, CI 0.41-0.57). Conclusion Certain occupations are associated with higher use of laryngological services presumably because of their vocational voice needs. In addition to confirming findings from other studies, we identified several new occupation groups with increased or decreased risk for laryngologic disorders. Understanding what factors predispose to requiring specialty voice evaluation may help in targeting preventative efforts.

Chronicity of Voice-Related Health Care Utilization in the General Medicine Community.

Objectives To examine voice-related health care utilization of patients in the general medical community without otolaryngology evaluation and explore factors associated with prolonged voice-related health care. Study Design Retrospective cohort analysis. Setting Large, national administrative US claims database. Subjects and Methods Patients with voice disorders per International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD-9-CM) codes from January 1, 2010, to December 31, 2012, seen by a general medical physician, and who did not see an otolaryngologist in the subsequent year were included. Voice-related health care utilization, patient demographics, comorbid conditions, and index laryngeal diagnosis were collected. Logistic regression with variable selection was performed to evaluate the association between predictors and ≥30 days of voice-related health care use. Results In total, 46,205 unique voice-disordered patients met inclusion criteria. Of these patients, 8.5%, 10.0%, and 12.5% had voice-related health care use of ≥90, ≥60, and ≥30 days, respectively. Of the ≥30-day subset, 80.3% and 68.5%, respectively, had ≥60 and ≥90 days of voice-related health care utilization. The ≥30-day subset had more general medicine and nonotolaryngology specialty physician visits, more prescriptions and procedures, and 4 times the voice-related health care costs compared with those in the <30-day subset. Age, sex, employment status, initial voice disorder diagnosis, and comorbid conditions were related to ≥30 days of voice-related health care utilization. Conclusions Thirty days of nonotolaryngology-based care for a voice disorder may represent a threshold beyond which patients are more likely to experience prolonged voice-related health care utilization. Specific factors were associated with extended voice-related health care.

Relationship between women's smoking and laryngeal disorders based on the urine cotinine test: results of a national population-based survey.

OBJECTIVES: There is a possibility of underestimation in the smoking rate surveyed by self-reported questionnaires. This study investigated the difference between the Korean female smoking rate as determined by self-reports and that determined by a biochemical test and elucidated the relationship between women's smoking and laryngeal disorders. DESIGN: Nationwide cross-sectional survey. SETTING: 2008 Korea National Health and Nutrition Examination Survey. PARTICIPANTS: 1849 women who completed the health survey, urinary cotinine test and laryngoscope examinations. MAIN OUTCOME MEASURE: This study defined smokers as those with urine cotinine contents of 50 ng/mL and over. Confounding factors included age, level of education, household income, occupation and problem drinking in the past year. For statistical tests, OR and 95% CI were presented by using complex samples logistic regression. RESULTS: While there was no relationship between smoking as determined by a self-reported questionnaire and laryngeal disorders, smoking as determined by the urine cotinine test had a significant relationship with laryngeal disorders (p<0.05). After all the confounding factors were adjusted, those with urine cotinine concentrations of over 50 ng/mL had a 2.1 times higher risk of laryngeal disorders than those with urine cotinine concentrations of <50 ng/mL (OR=2.05, 95% CI 1.11 to 3.78) (p<0.05). CONCLUSIONS: This national cross-sectional study verified that smoking is a significant risk factor for laryngeal disorders. Longitudinal studies are required to identify the causal relationship between smoking and laryngeal disorders.

Gender differences in risk factors of benign vocal fold disease in Korea: the fifth Korea National Health and Nutritional Examination Survey.

The aim of this study was to confirm the prevalence rate of benign vocal fold disease (BVFD) based on gender in the Korean adult population and investigate potential risk factors of BVFD. Subjects were 8,677 non-institutionalized civilian adults over the age of 19 (3,788 males and 4,899 females) who completed the laryngeal examination of the fifth Korea National Health and Nutrition Examination Survey. Poisson regression analyses were conducted to examine the potential risk factors of BVFD. The prevalence rates of BVFD were similar in men (2.7%) and women (2.6%). When adjusted for covariates, men with self-reported voice problems had a 6.7 times greater risk (RR 6.72, 95% CI 4.17-10.84) of BVFD (P < 0.01). In addition, women with self-reported voice problems (RR 4.71, 95% CI 3.01-7.37) and current smokers (RR 1.97, 95% CI 1.01-3.81) were more likely to have BVFD (P < 0.01). There are gender differences in the risk factors of BVFD. In order to prevent BVFD, the enactment of guidelines reflecting gender differences is required.

Otolaryngology utilization of speech-language pathology services for voice disorders.

OBJECTIVES/HYPOTHESIS: To examine the utilization of speech-language pathology (SLP) services by otolaryngology for outpatients with laryngeal/voice disorders. STUDY DESIGN: Retrospective analysis of a large, national, administrative US claims database. METHODS: The study population included patients with a laryngeal/voice disorder based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004 to December 31, 2008, seen by an otolaryngologist as an outpatient, and 12 months of follow-up. Data were collected on SLP evaluation and treatment and patient factors including age, gender, geographic region, employment status, initial laryngeal diagnosis, and laryngeal diagnosis change over 12 months. Multivariable logistic regression analysis was used to investigate factors associated with receipt of SLP evaluation and treatment. RESULTS: There were 91,898 unique patients who met study criteria. A total of 4,485 (4.9%) patients had an SLP evaluation, of whom 2,216 (49.4%) had at least one voice therapy session. Patient age, gender, geographic region, and laryngeal diagnosis were associated with increased likelihood of receiving SLP services. Patients whose final laryngeal diagnosis changed from their initial diagnosis had greater odds of having an SLP evaluation (odds ratio = 1.18, 95% confidence interval = 1.06-1.31) compared to patients without laryngeal diagnosis change. CONCLUSIONS: SLP evaluation and treatment occurred in a minority of laryngeal/voice-disordered patients. Further study is needed to assess the impact of SLP services on the healthcare utilization of patients with laryngeal/voice disorders. LEVEL OF EVIDENCE: 2C.

The association between lifetime cigarette smoking and dysphonia in the Korean general population: findings from a national survey.

This study aims to investigate the relationship between current smoking and lifetime amount smoked and the incidence of dysphonia using data from a national cross-sectional survey that represents the Korean population. Subjects were 3,600 non-institutionalised civilian adults over the age of 19 (1,501 males and 2,099 females) who completed the laryngeal examination of the 2008 Korea National Health and Nutrition Examination Survey (KNHANES). For lifetime amount smoked, subjects were classified as light smokers (≤26.7 pack years), medium smokers (26.7-40.5 pack years), heavy smokers (40.5-55.5 pack years), and very heavy smokers (55.5-156 pack years) based on pack years (packs smoked per day × years as a smoker). The odds ratio (OR) for the statistical test was presented using hierarchical logistic regression. When adjusted for covariates (age, gender, level of education, income, occupation, alcohol consumption and pain/discomfort during the last two weeks), current smokers had a 1.8 times (OR = 1.77, 95% CI [1.17-2.68]) higher risk for self-reported voice problems than non-smokers. Moreover, current smokers had a 1.6 times (OR = 1.56, 95% CI [1.02-2.38]) higher risk of laryngeal disorder (p < 0.05). In terms of pack years, very heavy smokers were significantly more likely to have laryngeal disorder, while self-reported voice problems were significantly more likely for heavy smokers but not very heavy smokers. The results of this study imply that chronic smoking has a significant relationship with dysphonia. Longitudinal studies are required in future work to verify the causality between lifetime smoking amount and dysphonia.

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.

Factors influencing referral of patients with voice disorders from primary care to otolaryngology.

OBJECTIVES/HYPOTHESIS: To evaluate the frequency, timing, and factors that influence referral of patients with laryngeal/voice disorders to otolaryngology following initial evaluation by a primary care physician (PCP). STUDY DESIGN: Retrospective analysis of a large, national 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 by a PCP as an outpatient (with or without otolaryngology involvement), and continuously enrolled for 12 months were included. Patient age, gender, geographic region, last PCP laryngeal diagnosis, comorbid conditions, time from first PCP visit to first otolaryngology visit, number of PCP outpatient visits, and number of PCP laryngeal diagnoses were collected. Cox and generalized linear regressions were performed. RESULTS: A total of 149,653 unique patients saw a PCP as an outpatient for a laryngeal/voice disorder, with 136,152 (90.9%) only seeing a PCP, 6,013 (4.0%) referred by a PCP to an otolaryngologist, and 3,820 (2.6%) self-referred to an otolaryngologist. Acute laryngitis had a lower hazard ratio (HR) for otolaryngology referral than chronic laryngitis, nonspecific dysphonia, and laryngeal cancer. Having multiple comorbid conditions was associated with a greater HR for otolaryngology referral than having no comorbidities. Patient age, gender, and geographic region also affected otolaryngology referral. The time to otolaryngology evaluation ranged from <1 month to >3 months. PCP-referred patients had less time to the otolaryngology evaluation than self-referred patients. CONCLUSIONS: Multiple factors affected otolaryngology referral for patients with laryngeal/voice disorders. Further education of PCPs regarding appropriate otolaryngology referral for laryngeal/voice disorders is needed.

Diagnosis change in voice-disordered patients evaluated by primary care and/or otolaryngology: a longitudinal study.

OBJECTIVE: Accurate diagnosis of a voice disorder is an essential first step toward its appropriate treatment. We examined differences in laryngeal diagnosis over time in outpatients evaluated by primary care physicians (PCPs) and/or otolaryngologists. STUDY DESIGN AND SETTING: Retrospective analysis of data from a large, national administrative US claims database. SUBJECTS AND METHODS: Patients with laryngeal disorders based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004, to December 31, 2008, with at least 2 outpatient visits by a PCP and/or otolaryngologist and continuously enrolled for 12 months were included. The initial and final laryngeal diagnoses were tabulated. RESULTS: Of approximately 55 million individuals, 29,501 met inclusion criteria. More than half the patients in the PCP to otolaryngology group and one-third of the otolaryngology to otolaryngology group had different laryngeal diagnoses over time. Three-fourths of patients with an initial acute laryngitis diagnosis in the PCP to otolaryngology group and half of the otolaryngology to otolaryngology group had a different final laryngeal diagnosis. Of patients with a final laryngeal cancer diagnosis, one-fourth of the otolaryngology to otolaryngology group had an initial diagnosis of nonspecific dysphonia, and one-fifth of the PCP to otolaryngology group had an initial diagnosis of acute laryngitis. CONCLUSION: Differential diagnosis of voice disorders often evolves over time. The impact on treatment and health care utilization are important areas of future study.

Prescribing patterns of primary care physicians and otolaryngologists in the management of laryngeal disorders.

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 SETTING: Retrospective 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. RESULTS: Of 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.

The Clinical Usefulness of Aerodynamic Test Using the Airway Interruption Method in Patients with Laryngeal Disorders / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The airway interruption method was developed as a combination of the measurement of expiratory pressure, mean air flow, intensity, and frequency. We evaluated the clinical usefulness of the airway interruption method in measuring vocal frequency, vocal intensity, mean air flow rate and expiratory air pressure. MATERIALS AND METHODS: We performed phonatory function tests in the patients with vocal nodule (n=380), vocal polyp (n=41), vocal sulcus (n=20), laryngitis (n=72), vocal paralysis (n=10) and glottic cancer, T 1 (n=5). And these results were compared with normal values which were reported previously. In 91 patients with vocal nodule and 5 patients with polyp, phonatory function test was followed up after laryngomicrosurgery and compared with preoperative test. RESULTS: In patients with vocal nodule and polyp, mean air flow rate was significantly increased (p<0.05). In polyp, these differences were greater than nodule group. In vocal paralysis, mean air flow rate was significantly increased than other groups. In glottic cancer (T1), expiratory air pressure was significantly increased than other groups. In laryngitis and sulcus vocalis, mean air flow rate was increased in some phonation methods. But their differences were less significant than other groups. After laryngomicrosurgery, mean air flow rate and expiratory air pressure were decreased in both groups. CONCLUSION: The aerodynamic test using the airway interruption method is a noninvasive, easy to perform and reliable for evaluation of aerodynamic conditions at the glottis. This research finds that the interruption method is effective both in evaluation of the treatment and in postoperative assessments of the laryngeal disorder patients.

Phoniatrical Evaluation of Various Laryngeal Disorders

In some specific measurement, observations, and analyses of certain aspects of the voice and voice production used in phoniatrics, signs of various laryngeal disorders were identified, indicating that these tools can be used as aids in the diagnosis of laryngeal disorders.