ORIGINAL RESEARCH– GENERAL OTOLARYNGOLOGY Primary care approach to dysphonia Richard Turley, MD, and Seth Cohen, MD, MPH, Durham, NC Sponsorships or competing interests that may be relevant to con- tent are disclosed at the end of this article ABSTRACT OBJECTIVE: To understand how primary care physicians man- age patients with dysphonia and the barriers they face when eval- uating patients for voice problems. STUDY DESIGN: Cross-sectional survey. SETTING: Primary care community. SUBJECTS AND METHODS: A total of 933 internal and family medicine physicians were randomly selected from a data- base of physicians in a referral basin of a tertiary care medical center and mailed a questionnaire. Questions concerned physician comfort level in recognizing an abnormal voice, their view of the quality of life impact of dysphonia, frequency of evaluating pa- tients for voice problems, barriers to the evaluation of voice prob- lems, reasons for referral, and common treatments prior to referral. RESULTS: A total of 271 physicians responded, for a response rate of 29.0 percent. Of those who responded, 36.5 percent rou- tinely evaluate their patients for voice problems. Reasons for not evaluating patients for voice problems were patients not complain- ing about hoarseness, more pressing issues, not feeling comfort- able assessing patients for voice problems, and time constraints. Chronic voice changes and not being able to understand patients’ speech were the most common reasons for referral. Reflux and allergy treatment were common treatment modalities prior to re- ferral. A total of 67.5 percent of respondents were interested in learning more about voice problems. CONCLUSION: Primary care physicians face limitations with respect to evaluating patients for voice problems. Otolaryngologists must continue outreach efforts and collaboration with primary care colleagues in order to enhance the screening for voice problems. © 2010 American Academy of Otolaryngology–Head and Neck Sur- gery Foundation. All rights reserved. V oice disorders affect roughly 30 percent of adults at some point in their lifetime, with associated impaired quality of life (QOL), decreased work productivity, and rising health care costs. 1,2 However, only a minority of people who have voice problems seek treatment. 1 Hence, improved health care services aimed at the early identifica- tion and treatment of patients with dysphonia are essential. Primary care physicians (PCPs) are in a unique position to detect the presence of dysphonia in their patients and direct them to appropriate treatment. PCPs treat many chronic conditions, direct patients’ health maintenance, are often the first physician to learn of a new problem, and are actively involved in preventive medicine. Screening for communication disorders, such as hearing loss, has been endorsed by the U.S. Preventive Services Task Force. 3 Through screening their patients for voice problems, PCPs also have the potential to improve the communication func- tion of their patients. Furthermore, otolaryngologists have recognized that PCPs play an important role in screening patients’ vocal health. Multiple reports have been written by otolaryngolo- gists describing the anatomy and physiology of voice pro- duction, signs and symptoms of dysphonia, vocal pathology, treatment for voice disorders, and the need for otolaryngology evaluation of dysphonia of two to three weeks duration. 4,5 In addition to identifying early stage laryngeal cancer, the ability of PCPs to recognize dysphonia and direct patients to treatment can lead to improved QOL and potentially to less time lost from work. In fact, the importance of listening to a patient’s voice has been stressed, and Maragos et al even produced an audiotape for PCP education. 6 Since patients with gradual, chronic voice changes may be minimally affected by their voice and consequently not complain of dysphonia, treatable dysphonia may go unnoticed. 7 Yet, it is unknown how comfortable PCPs are with recognizing voice problems and whether and how they address dysphonia. Fur- thermore, PCPs must manage multiple medical problems and may not have time to ask about dysphonia or be aware of the QOL impact. Hence, understanding and subsequently address- ing the limitations PCPs experience with respect to evaluating dysphonia are priorities for the otolaryngology community and necessary to enhance the health care services available for dysphonic patients. The purpose of this study was to examine PCPs’ ap- proach to evaluating and managing dysphonia. Our hypoth- esis is that PCPs do not routinely assess their patients for dysphonia and experience barriers with respect to screening for dysphonia. PCPs’ initial management for dysphonic patients will also be explored. Methods Approval was obtained from the Duke University Medical Center Institutional Review Board. An anonymous one- page questionnaire was mailed to internal and family med- Received August 25, 2009; revised December 2, 2009; accepted December 8, 2009. Otolaryngology–Head and Neck Surgery (2010) 142, 310-314 0194-5998/$36.00 © 2010 American Academy of Otolaryngology–Head and Neck Surgery Foundation. All rights reserved. doi:10.1016/j.otohns.2009.12.022