title: Diagnostic Delays in Spasmodic Dysphonia: A Call for Clinician Education.
abstract: OBJECTIVE
  Spasmodic dysphonia (SD) is a rare but often debilitating disease. Due to lack of awareness among practitioners and lack of well-defined diagnostic criteria, it can be difficult for patients with SD to receive a diagnosis and subsequent treatment. There is currently no literature documenting the efficacy of the medical community in recognizing and diagnosing this disorder. We aimed to quantify the patients' experiences with obtaining a diagnosis of SD.
  
  
  METHODS
  One hundred seven consecutive patients with SD completed questionnaires about their experiences with SD. Patients were recruited either during outpatient laryngology visits or during participation in a National Institutes of Health funded study investigating SD.
  
  
  RESULTS
  It took patients an average of 4.43 years (53.21 months) to be diagnosed with SD after first going to a physician with vocal symptoms. Patients had to see an average of 3.95 physicians to receive a diagnosis of SD. Patients (31.4%) had been prescribed medications other than botulinum toxin to treat their symptoms. Patients (30%) attempted alternative therapies for treatment of SD, such as chiropractor or dietary modification.
  
  
  CONCLUSIONS
  Despite advances in diagnostic modalities in medicine, the diagnosis of SD still remains elusive. Objective criteria for the diagnosis of SD and increased clinician education are warranted to address this diagnostic delay.
authors: Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts.
authors: Francis X
authors: FX
authors: Creighton
authors: Department of Otolaryngology-Head and Neck Surgery, Emory Voice Center, Emory University School of Medicine, Atlanta, Georgia.
authors: Edie
authors: E
authors: Hapner
authors: Department of Otolaryngology-Head and Neck Surgery, Emory Voice Center, Emory University School of Medicine, Atlanta, Georgia.
authors: Adam
authors: A
authors: Klein
authors: Department of Neurology, Emory University School of Medicine, Atlanta, Georgia.
authors: Ami
authors: A
authors: Rosen
authors: Department of Neurology, Emory University School of Medicine, Atlanta, Georgia.
authors: Hyder A
authors: HA
authors: Jinnah
authors: Department of Otolaryngology-Head and Neck Surgery, Emory Voice Center, Emory University School of Medicine, Atlanta, Georgia. Electronic address: michael.johns2@emory.edu.
authors: Michael M
authors: MM
authors: Johns
mesh_terms: D000328:Adult; D017668:Age of Onset; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D002983:Clinical Competence; D057210:Delayed Diagnosis; D055154:Dysphonia / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D004502:Education, Medical, Continuing; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D007318:Inservice Training; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D011237:Predictive Value of Tests; D011379:Prognosis; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D013997:Time Factors; D014833:Voice Quality / Q000187:drug effects
chemical_list: D019274:Botulinum Toxins, Type A
keywords: Diagnostic delay; Larynx; Spasmodic dysphonia; Voice