Multi-institutional Study of Voice Disorders and Voice Therapy Referral

Abstract

Objectives

To assess perspectives of patients with voice problems and identify factors associated with the likelihood of referral to voice therapy via the CHEER (Creating Healthcare Excellence through Education and Research) practice-based research network infrastructure.

Study Design

Prospectively enrolled cross-sectional study of CHEER patients seen for a voice problem (dysphonia).

Setting

The CHEER network of community and academic sites.

Methods

Patient-reported demographic information, nature and severity of voice problems, clinical diagnoses, and proposed treatment plans were collected. The relationship between patient factors and voice therapy referral was investigated.

Results

Patients (N = 249) were identified over 12 months from 10 sites comprising 30 otolaryngology physicians. The majority were women (68%) and white (82%). Most patients reported a recurrent voice problem (72%) and symptom duration >4 weeks (89%). The most commonly reported voice-related diagnoses were vocal strain, reflux, and benign vocal fold lesions. Sixty-seven percent of enrolled patients reported receiving a recommendation for voice therapy. After adjusting for sociodemographic and other factors, diagnoses including vocal strain/excessive tension and vocal fold paralysis and academic practice type were associated with increased likelihood of reporting a referral for voice therapy.

Conclusions

The CHEER network successfully enrolled a representative sample of patients with dysphonia. Common diagnoses were vocal strain, reflux, and benign vocal fold lesions; commonly reported treatment recommendations included speech/voice therapy and antireflux medication. Recommendation for speech/voice therapy was associated with academic practice type.

Keywords

CHEER voice therapy speech therapy voice problems voice disorders dysphonia reflux vocal strain vocal fold paralysis

Get full access to this article

View all access options for this article.

References

Cohen

Dupont

Courey

. Quality-of-life impact of non-neoplastic voice disorders: a meta-analysis. Ann Otol Rhinol Laryngol. 2006;115:128-134.

Cohen

Kim

Roy

Asche

Courey

. Direct health care costs of laryngeal diseases and disorders. Laryngoscope. 2012;122:1582-1588.

Cohen

Kim

Roy

Asche

Courey

. The impact of laryngeal disorders on work-related dysfunction. Laryngoscope. 2012;122:1589-1594.

Roy

Barkmeier-Kraemer

Eadie

. Evidence-based clinical voice assessment: a systematic review. Am J Speech Lang Pathol. 2013;22:212-226.

Watts

Hamilton

Toles

Childs

Mau

. A randomized controlled trial of stretch-and-flow voice therapy for muscle tension dysphonia. Laryngoscope. 2015;125:1420-1425.

Watts

Diviney

Hamilton

Toles

Childs

Mau

. The effect of stretch-and-flow voice therapy on measures of vocal function and handicap. J Voice. 2015;29:191-199.

Cohen

Garrett

. Utility of voice therapy in the management of vocal fold polyps and cysts. Otolaryngol Head Neck Surg. 2007;136:742-746.

Murry

Woodson

. A comparison of three methods for the management of vocal fold nodules. J Voice. 1992;6:271-276.

Sulica

Behrman

. Management of benign vocal fold lesions: a survey of current opinion and practice. Ann Otol Rhinol Laryngol. 2003;112:827-833.

10.

Verdolini-Marston

Burke

Lessac

Glaze

Caldwell

. Preliminary study of two methods of treatment for laryngeal nodules. J Voice. 1995;9:74-85.

11.

Mau

Jacobson

Garrett

. Factors associated with voice therapy outcomes in the treatment of presbyphonia. Laryngoscope. 2010;120:1181-1187.

12.

Liotti

Ramig

. Improvement of voicing in patients with Parkinson’s disease by speech therapy. Neurology. 2003;61:1316.

13.

Ramig

Verdolini

. Treatment efficacy: voice disorders. J Speech Lang Hear Res. 1998;41:S101-S116.

14.

Vashani

Murugesh

Hattiangadi

. Effectiveness of voice therapy in reflux-related voice disorders. Dis Esophagus. 2010;23:27-32.

15.

Van Lierde

Claeys

De Bodt

van Cauwenberge

. Long-term outcome of hyperfunctional voice disorders based on a multiparameter approach. J Voice. 2007;21:179-188.

16.

Andrews

Schmidt

. Congruence in personality between clinician and client: relationship to ratings of voice treatment. J Voice. 1995;9:261-269.

17.

Crane

Cooper

. Speech-language clinician personality variables and clinical effectiveness. J Speech Hear Disord. 1983;48:140-145.

18.

van Leer

Hapner

Connor

. Transtheoretical model of health behavior change applied to voice therapy. J Voice. 2008;22:688-698.

19.

Behrman

. Facilitating behavioral change in voice therapy: the relevance of motivational interviewing. Am J Speech Lang Pathol. 2006;15:215-225.

20.

Cohen

Kim

Roy

Asche

Courey

. Prevalence and causes of dysphonia in a large treatment-seeking population. Laryngoscope. 2012;122:343-348.

21.

Witsell

Rauch

Tucci

. The Otology Data Collection project: report from the CHEER network. Otolaryngol Head Neck Surg. 2011;145:572-580.

22.

Rosen

Lee

Osborne

Zullo

Murry

. Development and validation of the Voice Handicap Index-10. Laryngoscope. 2004;114:1549-1556.

23.

Harris

Taylor

Thielke

Payne

Gonzalez

Conde

. Research electronic data capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377-381.

24.

Harrell

. Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis. New York, NY: Springer; 2013.

25.

Creating Healthcare Excellence through Education and Research. Retrospective Data Collection Project. http://cheerresearch.org/projects/retrospective-data-collection-project/. Accessed January 15, 2016.

26.

Roy

Merrill

Gray

Smith

. Voice disorders in the general population: prevalence, risk factors, and occupational impact. Laryngoscope. 2005;115:1988-1995.

27.

Cohen

. Self-reported impact of dysphonia in a primary care population: an epidemiological study. Laryngoscope. 2010;120:2022-2032.

28.

Bhattacharyya

. The prevalence of voice problems among adults in the United States. Laryngoscope. 2014;124:2359-2362.

29.

Arffa

Krishna

Gartner-Schmidt

Rosen

. Normative values for the Voice Handicap Index-10. J Voice. 2012;26:462-465.

30.

Meyer

Hillel

. Voice disorders in the workplace: productivity in spasmodic dysphonia and the impact of botulinum toxin. Laryngoscope. 2013;123(suppl 6):S1-S14.

31.

Cohen

Pitman

Noordzij

Courey

. Evaluation of dysphonic patients by general otolaryngologists. J Voice. 2012;26:772-778.

32.

Cohen

Dinan

Roy

Kim

Courey

. Diagnosis change in voice-disordered patients evaluated by primary care and/or otolaryngology: a longitudinal study. Otolaryngol Head Neck Surg. 2014;150:95-102.

33.

Cohen

Kim

Roy

Wilk

Thomas

Courey

. Change in diagnosis and treatment following specialty voice evaluation: a national database analysis. Laryngoscope. 2015;125:1660-1666.

34.

Book

Rhee

Toohill

Smith

. Perspectives in laryngopharyngeal reflux: an international survey. Laryngoscope. 2002;112:1399-1406.

35.

Ahmed

Khandwala

Abelson

. Chronic laryngitis associated with gastroesophageal reflux: prospective assessment of differences in practice patterns between gastroenterologists and ENT physicians. Am J Gastroenterol. 2006;101:470-478.

36.

Randhawa

Nouraei

Mansuri

Rubin

. Allergic laryngitis as a cause of dysphonia: a preliminary report. Logoped Phoniatr Vocol. 2010;35:169-174.

37.

Roth

Ferguson

. Vocal allergy: recent advances in understanding the role of allergy in dysphonia. Curr Opin Otolaryngol Head Neck Surg. 2010;18:176-181.

38.

Keesecker

Murry

Sulica

. Patterns in the evaluation of hoarseness: time to presentation, laryngeal visualization, and diagnostic accuracy. Laryngoscope. 2015;125:667-673.

39.

Van Houtte

Van Lierde

D’Haeseleer

Claeys

. The prevalence of laryngeal pathology in a treatment-seeking population with dysphonia. Laryngoscope. 2010;120:306-312.

40.

Coyle

Weinrich

Stemple

. Shifts in relative prevalence of laryngeal pathology in a treatment-seeking population. J Voice. 2001;15:424-440.

41.

Best

Fakhry

. The prevalence, diagnosis, and management of voice disorders in a National Ambulatory Medical Care Survey (NAMCS) cohort. Laryngoscope. 2011;121:150-157.

42.

Cohen

Dinan

Kim

Roy

. Otolaryngology utilization of speech-language pathology services for voice disorders [published online August 26, 2015]. Laryngoscope.

43.

Miller

. Voice therapy for vocal fold paralysis. Otolaryngol Clin North Am. 2004;37:105-119.

44.

Behrman

. Evidence-based treatment of paralytic dysphonia: making sense of outcomes and efficacy data. Otolaryngol Clin North Am. 2004;37:75-104.

45.

Schneider

. Behavioral management of unilateral vocal fold paralysis and paresis. Perspectives on Voice and Voice Disorders. 2012;22:112-120.

46.

Lee

Hong

Choi

. Comparison of treatment modalities for contact granuloma: a nationwide multicenter study. Laryngoscope. 2014;124:1187-1191.

47.

Litts

Gartner-Schmidt

Clary

Gillespie

. Impact of laryngologist and speech pathologist coassessment on outcomes and billing revenue. Laryngoscope. 2015;125:2139-2142.

48.

Portone

Johns

3rd Hapner

. A review of patient adherence to the recommendation for voice therapy. J Voice. 2008;22:192-196.

49.

Duarte de Almeida

Santos

Bassi

Teixeira

Cortes Gama

. Relationship between adherence to speech therapy in patients with dysphonia and quality of life. J Voice. 2013;27:617-621.