Practice Patterns of Referring Physicians in Management of the Dysphonic Patient

Objective Dysphonia is commonly encountered by primary care physicians and general otolaryngologists. We examine practice patterns of referring physicians to a tertiary voice clinic, including adherence to evidence-based guidelines. Study Design Retrospective case series with chart review. Setting Academic tertiary care hospital. Subjects and Methods In total, 821 charts of patients with voice complaints seen at a tertiary voice clinic between January 2011 and June 2016 were reviewed. Included charts (n = 755) were reviewed for type of referring provider, prior diagnoses, and treatments employed by referring physicians. Additional information regarding findings at the time of laryngoscopy/stroboscopy and diagnoses provided by a laryngologist were also obtained. Statistical analysis was performed to determine significant relationships between variables of interest. Results A total of 244 patients (32.2%) received a diagnosis prior to evaluation in the voice clinic, most commonly laryngopharyngeal reflux disease (n = 134). Prior medical treatment was attempted in 221 (29.3%) patients, typically antireflux medications (n = 141). Of the patients treated with proton pump inhibitors by referring physicians, 65.1% lacked symptoms of gastroesophageal reflux disease. Patients with prior treatment had a median duration of symptoms 6 weeks longer than those without prior treatment ( P = .04). Among previously diagnosed patients, 199 (81.6%) of diagnoses changed after evaluation in the voice clinic. Conclusion Referring physicians frequently treat dysphonic patients empirically, often with antireflux medications. Subspecialist evaluation results in changes in diagnosis in many patients. Empiric treatment can delay referral and appropriate treatment.