EVMS Otolaryngologists, Drs. Benjamin J. Rubinstein and John T. Sinacori, discuss the Clinical Practice Guideline for Hoarseness. The guideline helps clarify appropriate treatment for patients presenting with voice change, whether or not that is their chief complaint.
Hi I'm dr Ben rubenstein and I work at the Eastern Virginia Medical School. Voice and swallowing center with dr john cena Corey. Today we will be discussing the clinical practice guideline for hoarseness. This guideline was released by the American Academy of Otolaryngology. Had annexed surgery and it was endorsed by the American Psychological Association. The guideline helps clarify appropriate treatment for patients presenting with a voice change whether or not it was their chief complaint at the date of service. Dysphonia is characterized by a change in vocal quality, pitch, volume or vocal effort that makes it difficult to communicate. Patients often report this as hoarseness. Sometimes patients will notice the change and other times it is noticed by their family friends or a physician. Most as Phony as due to an upper respiratory tract infection and goes away in about 7-10 days. If the horses does not resolve or improve in 3-4 weeks. It's important to seek further evaluation. Other causes can include voice overuse allergies, reflux, neurologic or inflammatory conditions, infections, medication, side effects or cancerous and precancerous growths. Patients who have had recent head, neck or chest surgery or endotracheal tube intubation are also at risk for vocal cord weakness. If there are any red flags such as a smoking history, recent surgery or intubation, breathing issues or even a neck mass. It is appropriate to refer immediately referral is also warranted in any patient whose dysphonia does not resolve after four weeks from onset. Occasionally radiographic imaging such as the CT or MRI scan is useful in the work up of a patient with hoarseness but it is only recommended after a patient has had a laryngeal examination by an otolaryngologist. The consensus from the clinical practice guideline recommends against using reflux medication, antibiotics or oral steroids for persistent hoarseness prior to a laryngeal examination. This recommendation does not apply if the medications are used to treat another condition, such as a strep infection. The laryngeal examination is fairly specific in identifying any medication most suitable for treatment of the patients. Voice change If medication is indeed warranted, voice therapy consists of a variety of tests designed to eliminate harmful vocal behavior, shape healthy vocal behavior and assist in vocal fold, wound healing after surgery or injury. Voice therapy is useful for a variety of causes of hoarseness but is only indicated after appropriate learning jewel evaluation. Voice therapy for dysphonia generally consists of one or two therapy sessions each week for 4 to 8 weeks. The first step in patient evaluation is a careful history and physical exam at Eastern Virginia Medical School. The patient then has a Lawrenceville stra bOSC Api, which is an advanced Lawrenceville imaging technology that allows high definition video of vocal court appearance and vibration In real time. This exam can be done with a telescope in the patient's mouth or a small flexible camera, which passes through the nose. The exam is very well tolerated and safe. The lettering geologists then reviews the strobe aske opic examination with the patient. The visit concludes with shared decision making for the next step in treatment.