title: Multi-institutional Study of Voice Disorders and Voice Therapy Referral: Report from the CHEER Network.
abstract: 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.
  
  
  
  Prospectively enrolled cross-sectional study of CHEER patients seen for a voice problem (dysphonia).
  
  
  
  The CHEER network of community and academic sites.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Lions Voice Clinic, Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Misono
authors.affiliation: Lions Voice Clinic, Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Schelomo
authors.initials: S
authors.lastname: Marmor
authors.affiliation: Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah, USA.
authors.forename: Nelson
authors.initials: N
authors.lastname: Roy
authors.affiliation: Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Ted
authors.initials: T
authors.lastname: Mau
authors.affiliation: Duke Voice Care Center, Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, North Carolina, USA seth.cohen@duke.edu.
authors.forename: Seth M
authors.initials: SM
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D006302:Health Services Research; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D010036:Otolaryngology / Q000458:organization & administration; D011446:Prospective Studies; D012017:Referral and Consultation; D014481:United States; D014832:Voice Disorders / Q000453:epidemiology / Q000534:rehabilitation*
keywords: CHEER; dysphonia; reflux; speech therapy; vocal fold paralysis; vocal strain; voice disorders; voice problems; voice therapy