The Prevalence, Diagnosis, and Management of Voice Disorders in a National Ambulatory Medical Care Survey (NAMCS) Cohort

Objectives: The purpose of this study was to analyze the prevalence, presentation, and treatment of voice complaints (VC) using a national cohort of ambulatory care patients and describe how this care conforms to guidelines for the treatment of vocal disorders. Methods: Cross-sectional study of 2005-2007 National Ambulatory Medical Care Survey (NAMCS) database. Results: Of 87,835 outpatient encounters, 0.26% and 3.2% of total and otolaryngology visits, respectively, were for VC. Patients with a VC were more likely to be female, have a history of asthma and tobacco use, present with acute symptoms, and have been referred to a specialist than those without VC. As recommended in national guidelines, the most common diagnostic procedure was endoscopic laryngoscopy (22%) with few other diagnostic imaging modalities performed (8%). Laryngeal diagnoses were more common than infectious or gastrointestinal diagnoses and were more likely to be chronic in presentation and associated with a diagnostic laryngoscopy evaluation (P = .02, <. 001). They were not associated with gender, age, or tobacco use (P = .51, .35, .07). The most common intervention was antireflux medication (27%), with 13% receiving antibiotics, usually from primary care physicians. Only 8% were referred for voice therapy, despite strong national recommendations to consider this intervention for those with voice disorders. Conclusions: The current study demonstrates that nationally a significant proportion of diagnostic and treatment plans for patients with VC are consistent with published guidelines. However, physicians from all specialties should be aware of these guidelines to improve care for patients with voice disorders.