Diagnostic testing for vocal fold paralysis: survey of practice and evidence-based medicine review.

摘要: Objectives/Hypothesis: Vocal fold paralysis continues to be a dominant topic in laryngology. Although the majority of cases can attributed known etiology, significant number patients present without clear precipitating event. Over 1,500 studies regarding vocal exist medical literature, although only small percentage report on use serum or radiographic testing for evaluation idiopathic paralysis. Despite this, are routinely subjected diagnostic investigate underlying cause. To characterize contemporary practice, national survey American Broncho-Esophagological Association (ABEA) membership was undertaken. It is hypothesized that current practice not well supported by an evidence-based medicine (EBM) review available literature. Study Design: The authors conducted survey, systematic EBM existing literature. Methods: Surveys were mailed all active ABEA members; responses specialization as serum/radiographic preferences tabulated and statistical analysis. compare with evidence first performed. Articles selected from Medline search English-language abstracts related adult publications individually reviewed level grade assigned compared results. Results: Eighty-four 249 members responded 76 (31%) replies submitted Specific tests advocated 41 (54%) respondents, (52 65 [80%]) felt they “occasionally” “never” necessary. most common rheumatoid factor (38%), Lyme titer (36%), erythrocyte sedimentation rate (34%), antinuclear antibody (33%). Fifty-one 71(72%) computed tomography (CT) “always” “often” necessary 50 72 (69%) replied chest radiography (CXR) There no difference between CT CXR ordering (P < .51). In contrast, magnetic resonance imaging (MRI) described 28 71 (39%) surveys, significantly less than .0001). impact = .25) .50 CT; P .46 CXR; .45 MRI). Following analysis 1,510 abstracts, 19 found appropriate 15 imaging. Only one study presented III evidence; remainder levels IV V comprised retrospective series case reports. supporting toward given overall “C.” Conclusions: Serum “C” only. prospective estimating clinical diagnosis patient outcome. Current estimated membership, founded regard Further into nature outcomes assessment paradigms may improve practice.