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Wednesday, April 12, 2017

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Case Example Vocal Tremor Response to BotoxSlide 01 Common Voice Disorders Dysphonia What is your diagnosisSlide 02 Common Voice Disorders Diagnosis and TreatmentSlide 03 Common Voice Disorders PostopSlide 04 Common Voice Disorders Normal Videostroboscopy
Slide 05a Common Voice Disorders DysarthriaSlide 05b Common Voice Disorders Asthenia and TremorSlide 05c Common Voice Disorders Bilateral Vocal Cord ParalysisSlide 05d Bilateral Vocal Cord Paralysis with Dysphonia and DysphagiaSlide 06a Common Voice Disorders Voice Without Vocal Cords
Slide 06b Common Voice Disorders Acute Viral LaryngitisSlide 07 Common Voice Disorders Fungal LaryngitisSlide 08 Common Voice Disorders Laryngeal ParalysisSlide 09 Common Voice Disorders Muscle Tension DysphoniaSlide 10 Diagnosis

 

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Findings on laryngoscopy

 

Excision of laryngeal mass

 

Excision of laryngeal mass

 

Slide4.JPG

Shortfalls of the American Academy of Otolaryngology-Head and Neck Surgery Clinical Practice Guidelines: Hoarseness (Dysphonia)

Reference: Otolaryngol Head Neck Surg. 2010 Aug;143(2):175-7; discussion 175-80. doi: 10.1016/j.otohns.2010.05.026  (Johns et al 2010)

Comments from this publications addressing the above Clinical Practice Guidelines:

  1. The recommended performance of laryngoscopy after 3 months of hoarseness was pointed out as a longer interval than the 2 to 4 weeks recommended from prior AAO-HNS documents
  2. The 'decision to confuse the difference between a symptom (hoarsness) and a diagnosis leads to several misleading statements'
  3. The commentary identifies another 'shortfall' in the sentence 'a balance of benefits vs harm for laryngoscopy and hoarseness' was thought to over emphasize the potential harm. These critics of the CPG (clinical practice guideline) relate that 'with the exception of minimal epistaxis and temproary discomfort, there are no published reports of harm from office laryngosocpy."
  4. The comments also include the affirmation that visualization of the larynx to evaluate hoarsenss should not be considered an option, but rather a strong recommendation in that it plays a crucial role in the evaluation of hoarseness. These commentators emphasize that patients with chronic voice changes require laryngoscopy and not empiric treatment.
  5. Problems with 'insufficient peer review' were also brought up

References

Ruiz R, Jeswani S, Andrews K, Rafii B, Paul BC, Branski RC, and Amin MR: Hoarseness and laryngopharyngeal reflux: a survey of primary care physician practice patterns  JAMA Otolaryngology Head Neck Surg. 2014 Mar;140(3):192-6

Otolaryngol Head Neck Surg. 2009 Sep;141(3 Suppl 2):S1-S31. doi: 10.1016/j.otohns.2009.06.744.
Schwartz SR, Cohen SM, Dailey SH, Roesnfeld RM, Deutsch ES, Gillespie MB, GranieriE, Hapner ER, Kimball CE, Krouse HJ, McMurray JS, Medina S, O'Brien K, Oellette DR, Messinger-Rapport BJ, Stachler RJ, Strode S, Thompson DM, Stemple JC,
Willging JP, Cowley T, McCoy S, Bernad PG, Patel MM: Clinical practice guideline: hoarseness (dysphonia) Otolaryngol Head Neck Surg 2009;141 (Suppl 2):S1-31

Johns M, Sataloff RT, Merati AL, and Rosen CA  Shortfalls of the American Academy of Otolaryngology-Head and Neck Surgery's Clinical Practice Guideline: Hoarseness (Dysphonia). Otolaryngology – Head and Neck Surgery 2010 vol:143 iss:2 pp 175-177

Turley R and Cohen S: Primary care approach to dysphonia. Otolaryngology–Head and Neck Surgery (2010) 142, 310-314

Mitka M: New Clinical Guideline for Hoarseness Offers Assessment and Treatment Advice. JAMA 2009;302(18):1954-1956

Mau T: Diagnostic Evaluation and Management of Hoarseness  Medical Clinics of Noarth America 95 (2010) 945-960

Michael M.JohnsIIIMD,  Robert T.SataloffMD, DMA, Albert L.MeratiMD, Clark A.RosenMD: Shortfalls of the American Academy of Otolaryngology–Head and Neck Surgery's Clinical practice guideline: Hoarseness (Dysphonia) Otolaryngology - Head and Neck SurgeryVolume 143, Issue 2, August 2010, Pages 175-177 [Otolaryngology - Head and Neck Surgery]Commentary