title: Does Even Low-Grade Dysphonia Warrant Voice Center Referral?
abstract: OBJECTIVE
  Data regarding the referral of dysphonic patients to specialty voice clinics are limited. The objective of this study is to examine the relationship between low perceptual dysphonia severity and subtle laryngeal findings to discern if this can help guide referral.
  
  
  METHODS
  This is a retrospective chart review.
  
  
  METHODS
  The charts of 94 patients presenting with a primary complaint of hoarseness to a single laryngologist over a 1-year period at a tertiary care, interdisciplinary voice center were analyzed. Patients were stratified by clinician perceptual rating of dysphonia severity using the overall Grade score from the GRBAS (grade, roughness, breathiness, asthenia, strain) scale, and this was compared to their laryngeal findings on stroboscopy.
  
  
  RESULTS
  Forty-one patients had a Grade score of 0 or 1, of whom 85% had relatively subtle findings on stroboscopy, including vocal fold paresis, muscle tension dysphonia, and spasmodic dysphonia.
  
  
  CONCLUSIONS
  Patients with a primary complaint of hoarseness but absent or only mild perceptual dysphonia may have subtle or occult laryngeal findings that may be easily missed. These patients may benefit from early referral to a specialty voice center.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania. Electronic address: Resha.Soni@tuhs.temple.edu.
authors.forename: Resha S
authors.initials: RS
authors.lastname: Soni
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania; Department of Speech Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Barbara
authors.initials: B
authors.lastname: Ebersole
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania; Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Nausheen
authors.initials: N
authors.lastname: Jamal
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001307:Auditory Perception; D000066491:Clinical Decision-Making; D055154:Dysphonia / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006685:Hoarseness / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007600:Judgment; D007830:Larynx / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010036:Otolaryngology; D015143:Philadelphia; D011237:Predictive Value of Tests; D012017:Referral and Consultation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013068:Speech Production Measurement; D049489:Stroboscopy; D062606:Tertiary Care Centers; D014833:Voice Quality
keywords: Dysphonia; GRBAS; Hoarseness; Perceptual voice evaluation; Stroboscopy