Hoarseness and laryngopharyngeal reflux: a survey of primary care physician practice patterns.
OBJECTIVE
Current approaches to the diagnosis and subsequent management of specific voice disorders vary widely among primary care physicians (PCPs). In addition, sparse literature describes current primary care practice patterns concerning empirical treatment for vocal disorders.


OBJECTIVE
To examine how PCPs manage patients with dysphonia, especially with regard to laryngopharyngeal reflux.


METHODS
Prospective, questionnaire-based study by an academic laryngology practice among academic PCPs from all major US geographic regions.


METHODS
A 16-question web-based survey, distributed via e-mail, concerning management and possible empirical treatment options for patients with dysphonia.


RESULTS
Of 2441 physicians who received the e-mail broadcast, 314 (12.9%) completed the survey. Among those who completed the survey, 46.3% were family practitioners, 46.5% were trained in internal medicine, and 7.2% identified as specialists. Among all respondents, 64.0% preferred to treat rather than immediately refer a patient with chronic hoarseness (symptoms persisting for >6 weeks) of unclear origin. Reflux medication (85.8%) and antihistamines (54.2%) were the most commonly selected choices for empirical treatment. Most physician respondents (79.2%) reported that they would treat chronic hoarseness with reflux medication in a patient without evidence of gastroesophageal reflux disease.


CONCLUSIONS
Most PCPs who responded to our survey report empirically treating patients with chronic hoarseness of unknown origin. Many physician respondents were willing to empirically prescribe reflux medication as primary therapy, even when symptoms of gastroesophageal reflux disease were not present. These data suggest that PCPs strongly consider reflux a common cause of dysphonia and may empirically treat patients having dysphonia with reflux medication before referral.
Department of Otolaryngology-Head and Neck Surgery, NYU Voice Center, New York University School of Medicine, New York, New York.
Ryan
R
Ruiz
Department of Otolaryngology-Head and Neck Surgery, NYU Voice Center, New York University School of Medicine, New York, New York.
Seema
S
Jeswani
Department of Otolaryngology-Head and Neck Surgery, NYU Voice Center, New York University School of Medicine, New York, New York.
Kenneth
K
Andrews
Department of Otolaryngology-Head and Neck Surgery, NYU Voice Center, New York University School of Medicine, New York, New York.
Benjamin
B
Rafii
Department of Otolaryngology-Head and Neck Surgery, NYU Voice Center, New York University School of Medicine, New York, New York.
Benjamin C
BC
Paul
Department of Otolaryngology-Head and Neck Surgery, NYU Voice Center, New York University School of Medicine, New York, New York.
Ryan C
RC
Branski
Department of Otolaryngology-Head and Neck Surgery, NYU Voice Center, New York University School of Medicine, New York, New York.
Milan R
MR
Amin
D006685:Hoarseness / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D057045:Laryngopharyngeal Reflux / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D058007:Physicians, Primary Care / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011446:Prospective Studies; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D014481:United States