September 3, 2009

New Guidelines For Treatment of Hoarseness

Hoarseness, also called dysphonia, is a disorder characterized by altered vocal quality, pitch, loudness, or vocal effort that impairs communication or reduces voice-related quality of life. Hoarseness may affect anyone, from newborns and infants to adults of any age.

A recent survey by the American Academy of Otolaryngology "“ Head and Neck Surgery Foundation (AAO-HNSF) found many Americans were unfamiliar with the possible causes and appropriate treatment for hoarseness. Almost half of the adults surveyed were not aware that persistent hoarseness can be a symptom of cancer. Separate research also found that only 5.9 percent of those with hoarseness sought treatment.

AAO-HNS has issued a national clinical practice guideline to help healthcare practitioners identify and manage patients with hoarseness. The guideline emphasizes evidence-based management of hoarseness by clinicians and educates patients about this common vocal health issue.

"Hoarseness affects approximately 20 million people in the U.S. at any given time, and about one in three individuals will become hoarse at some point in their life," Richard M. Rosenfeld, MD, MPH, chair of the American Academy of Otolaryngology "“ Head and Neck Surgery Foundation (AAO-HNSF) Guideline Development Task Force was quoted as saying. "In addition to the impact on health and quality of life, hoarseness leads to frequent healthcare visits and several billion dollars in lost productivity annually from work absenteeism."

"Most hoarseness is caused by benign or self-limiting conditions, but it may also be the presenting symptom of a more serious or progressive condition requiring prompt diagnosis and management," Seth R. Schwartz, MD, MPH, chair of the Hoarseness Guideline Panel was quoted as saying. "This new guideline is intended to enhance diagnosis, promote appropriate therapy, improve outcomes, and to expand counseling and education for prevention."

Hoarseness is more common in women "“ 50 percent higher than in men -- in children, especially ages 8 to 14 years, the elderly, and in professional voice users such as teachers, performers, telemarketers and aerobics instructors. Recognizing that patients who do seek treatment may see many different types of healthcare providers, the guidelines are intended for all clinicians who are likely to diagnose and manage patients with hoarseness.

Key features of the new guideline include suggestions that while hoarseness is usually the result of benign or self-limiting factors, clinicians should not ignore the possibility of a serious underlying condition such as a tumor of the larynx or medication side effects. Laryngoscopy, an office procedure to visualize the voice box and vocal cords, should be performed if hoarseness persists or if the cause is uncertain.

Guidelines state that anti-reflux medicines should not be prescribed for hoarseness unless there are symptoms of gastroesophageal reflex disease (GERD), such as heartburn or regurgitation, or signs of inflammation of the larynx seen during laryngoscopy.

The risk of hoarseness may be reduced by preventive measures such as staying well-hydrated, avoiding irritants, especially tobacco smoke, voice training, and amplification during heavy voice use.

"In an era of health reform and comparative effectiveness research, well-crafted guidelines help improve quality, promote optimal outcomes, minimize harm, and reduce inappropriate variations in care," said Dr. Rosenfeld. "It is hoped that these guidelines will give clinicians the tools they need to spot an issue early, avoid poor outcomes, and reduce healthcare costs."

SOURCE: National guideline issued by the American Academy of Otolaryngology "“ Head and Neck Surgery Foundation (AAO-HNSF), Alexandria, Va., September 1, 2009