2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

Otolaryngology–Head and Neck Surgery 00(0)

be a legal standard of care. The responsible physician, in light of all circumstances presented by the individual patient, must determine the appropriate treatment. Adherence to these guidelines will not ensure successful patient outcomes in every situation. The AAO- HNSF emphasizes that these clinical guidelines should not be deemed to include all proper treatment decisions or methods of care or to exclude other treatment decisions or methods of care reason- ably directed to obtaining the same results. Author Contributions Robert J. Stachler, writer, chair; David O. Francis, writer, assistant chair; Seth R. Schwartz, writer, methodologist; Cecelia C. Damask, writer; German P. Digoy, writer; Helene J. Krouse, writer; Scott J. McCoy, writer; Daniel R. Ouellette, writer; Rita R. Patel, writer; Charles (Charlie) W. Reavis, writer; Libby J. Smith, writer; Marshall Smith, writer; Steven W. Strode, writer; Peak Woo, writer; Lorraine C. Nnacheta, writer, AAO-HNSF staff liaison. Disclosures Competing interests: David O. Francis, research funding from the Patient Centered Outcomes Research Institute and National Institute on Deafness and Other Communication Disorders; Seth R. Schwartz, conference travel expenses for Cochlear Americas, Oticon Medical, and Cochlear Corporation (2013); Cecelia C. Damask, consulting fee fromAudigy Medical, honoraria from Teva Respiratory, and webinar speaker for ALK; Helene J. Krouse, Society of Otorhinolaryngology and Head-Neck Nurses Research Award (principal investigator, no salary support), AAO-HNSF and Society of Otorhinolaryngology and Head-Neck Nurses editorial boards, and AAO-HNSF editor in chief (self and partner); Daniel R. Ouellette, principal investigator for clinical trial with Cardeas Pharmaceuticals, which examines the treatment of ventilator-associated pneumonia in the intensive care unit with inhaled amikacin/fosfomycin versus placebo; expert wit- ness for law firm of Marynell Maloney for a case involving pulmo- nary embolism; chair, guideline oversight committee for American College of Chest Physicians; Rita R. Patel, American Speech- Language-Hearing Association Special Interest Group 3 coordinator; Charles (Charlie) W. Reavis, National Spasmodic Dysphonia Association board member and president; Libby J. Smith, Olympus product focus group; Steven W. Strode, American Academy of Family Physicians, federal-level lobbying; Lorraine C. Nnacheta, salaried employee, AAO-HNSF. References 1. Cohen SM, Kim J, Roy N, et al. Prevalence and causes of dys- phonia in a large treatment—seeking population. Laryngoscope . 2012;122:343-348. 2. Reiter R, Hoffmann TK, Pickhard A, Brosch S. Hoarseness— causes and treatments. Dtsch Arztebl Int . 2015;112:329-337. 3. Cohen SM. Self-reported impact of dysphonia in a primary care population. Laryngoscope . 2010;120:2022-2032. 4. Johns MM 3rd, Sataloff RT, Merati AL, et al. Shortfalls of the American Academy of Otolaryngology—Head and Neck Sur- gery’s clinical practice guideline: hoarseness (dysphonia). Oto- laryngol Head Neck Surg . 2010;143:175-180. 5. Jones K, Sigmon J, Hock L, et al. Prevalence and risk factors for voice problems among telemarketers. Arch Otolaryngol Head Neck Surg . 2002;128:571-577. Sponsorships: AAO-HNSF. Funding source: AAO-HNSF.

5: Botulinum Toxin (KAS 11) A need exists to better understand the pathophysiology of laryngeal dystonia to develop more effective treatments. It is also necessary to learn about which patients and factors pre- dict better or worse outcomes with botulinum toxin and what other alterative interventions might be beneficial to this patient population. 6: Education/Prevention (KAS 12) Prevention and education are paramount to reducing the bur- den of disease and disease recidivism. This requires a clearer understanding of preventive factors, healthy behaviors, and effective methods to effect and disseminate this information. In addition, it is important to better understand what factors increase the likelihood of developing voice disorders such that these groups can be targeted for educational and preven- tive interventions. Further work is needed to better understand the underpin- nings of MTD and functional dysphonia to help in prevention, education, and the management of these conditions. 7: Outcomes (KAS 13) Outcome assessment in voice disorders needs to be better standardized and refined. Patient-centered outcome measures and instrumental assessment need to be carefully and rigor- ously evaluated to determine their usefulness and reasonable- ness at the point of care. Better standardization of measurement would allow for better comparison across treatment and to better define disease severity and affect patient QOL and function. Acknowledgments We gratefully acknowledge the support provided by Jackie Cole, from the AAO-HNSF, for her assistance with this guideline’s graphic designs and Rachel Posey, MS, for her assistance with the literature searches. In addition, we acknowledge the work of the original guideline development group, which includes Seth R. Schwartz, MD, MPH; Seth Cohen, MD, MPH; Seth Dailey, MD; Richard M. Rosenfeld, MD, MPH; Ellen Deutsch, MD; M. Boyd Gillespie, MD, MS; Evelyn Granieri, MD, MPH, MEd; Barbara Messinger-Rapport, MD, PhD; Edie Hapner, PhD; Joseph Stemple, MD; PhD; Eve Kimball, MD; Safdar Medina, MD; J. Scott McMurray, MD; Paul Willging, MD; Helene J. Krouse, PhD; Karen O’Brien, MD; Steven Strode, MD, MEd, MPH; Daniel Ouellette, MD; Robert Stachler, MD; Scott McCoy, DMA; Terrie Crowley; Peter Bernad, MD, MPH; and Dana Thompson, MD, MS. Disclaimer This CPG is not intended as an exhaustive source of guidance for managing dysphonia (hoarseness). Rather, it is designed to assist clinicians by providing an evidence-based framework for decision- making strategies. The guideline is not intended to replace clinical judgment or establish a protocol for all individuals with this condi- tion and may not provide the only appropriate approach to diagnos- ing and managing this program of care. As medical knowledge expands and technology advances, clinical indicators and guidelines are promoted as conditional and provisional proposals of what is recommended under specific conditions, but they are not absolute. Guidelines are not mandates. These do not and should not purport to

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