By EurekAlert
Tuesday, September 1, 2009
Alexandria, Va. - The American Academy of Otolaryngology –
Head and Neck Surgery Foundation (AAO-HNSF) will issue the
first--and only--national clinical practice guideline to help
healthcare practitioners identify and manage patients with
hoarseness, also known as dysphonia. The guideline emphasizes
evidence-based management of hoarseness by clinicians, and educates
patients on the prevalence of this common vocal health issue.
"Hoarseness affects approximately 20 million people in the U.S.
at any given time, and about one in three individuals will become
hoarse at some point in their life," said Richard M. Rosenfeld, MD,
MPH, an author of the guideline and chair of the AAO-HNSF Guideline
Development Task Force. "In addition to the impact on health and
quality of life, hoarseness leads to frequent healthcare visits and
several billion dollars in lost productivity annually from work
absenteeism."
The terms hoarseness and dysphonia are often used
interchangeably, however, hoarseness is a symptom of altered voice
quality and dysphonia is a diagnosis. Hoarseness (dysphonia) is
defined as a disorder characterized by altered vocal quality,
pitch, loudness, or vocal effort that impairs communication or
reduces voice-related quality of life. Hoarseness may affect
newborns, infants, children, and adults of any age. Individuals
with hoarseness have impaired communication with their family and
peers, which may result in depression, social isolation, missed
work, lost wages, or reduced quality of life.
"Most hoarseness is caused by benign or self-limiting
conditions, but it may also be the presenting symptom of a more
serious or progressive condition requiring prompt diagnosis and
management," said Seth R. Schwartz, MD, MPH, chair of the
Hoarseness Guideline Panel. "This new guideline is intended to
enhance diagnosis, promote appropriate therapy, improve outcomes,
and to expand counseling and education for prevention."
Hoarseness is more common in women (50% higher than men),
children (peak range 8-14 years), the elderly, and professional
voice users (e.g., teachers, performers, telemarketers, aerobics
instructors). In spite of how common the condition is, a recent
survey by the AAO-HNS revealed that many Americans are unfamiliar
with the possible causes and appropriate treatment for hoarseness.
The survey revealed that almost half of adults are not aware that
persistent hoarseness may be a symptom of cancer. Separate research
cited in the guideline also found that only 5.9 percent of those
with hoarseness seek treatment.
Recognizing that patients who do seek care may see many
different types of healthcare providers, the guidelines are
intended for all clinicians who are likely to diagnose and manage
patients with hoarseness.
Key features of the new guideline include:
- Most, but not all, hoarseness is the result of benign
underlying or self-limiting factors; however, clinicians should
consider the possibility of a serious underlying condition (growth
or tumor of the larynx) or medication side effects as a cause.
- Laryngoscopy is an office procedure to visualize the larynx
(voice box and vocal cords) that should be performed if hoarseness
persists or if the cause is uncertain.
- Imaging studies, such as a CT or MRI scans, should not be
obtained for a primary complaint of hoarseness prior to visualizing
the larynx; laryngoscopy is the primary diagnostic modality and
should be done first.
- Anti-reflux medicines should not be prescribed for hoarseness
unless there are (a) signs or symptoms of gastroesophageal reflex
disease (GERD), such as heartburn or regurgitation, or (b) signs of
inflammation of the larynx seen during laryngoscopy.
- Steroids or antibiotics given by mouth are not recommended for
hoarseness and should not be used routinely.
- Voice therapy is a well-established intervention for hoarseness
that can be performed at any age. Laryngoscopy should be performed
prior to voice therapy and results communicated to the
speech-language pathologist. Therapy for hoarseness usually
includes one to two sessions per week for four to eight weeks.
- Surgery is not the primary treatment for most hoarseness, but
may be indicated for suspected cancer, other tumors or growths,
abnormal movement of the vocal cords, or abnormal tone of the vocal
cord muscles.
- The risk of hoarseness may be reduced by preventive measures
such as staying well-hydrated, avoiding irritants (especially
tobacco smoke), voice training, and amplification during heavy
voice use.
"In an era of health reform and comparative effectiveness
research, well-crafted guidelines help improve quality, promote
optimal outcomes, minimize harm, and reduce inappropriate
variations in care," says Dr. Rosenfeld. "It is hoped that these
guidelines will give clinicians the tools they need to spot an
issue early, avoid poor outcomes, and reduce healthcare costs."
The guideline was created by a multidisciplinary panel
representing neurology, speech-language pathology, professional
voice teaching, family medicine, pulmonology, geriatric medicine,
nursing, internal medicine, otolaryngology – head and neck
surgery, pediatric medicine, and consumers.
SOURCE