Clinical Practice Guideline: Hoarseness (Dysphonia) (Update).

摘要: Objective This guideline provides evidence-based recommendations on treating patients who present with dysphonia, which is characterized by altered vocal quality, pitch, loudness, or effort that impairs communication and/or quality of life. Dysphonia affects nearly one-third the population at some point in its applies to all age groups evaluated a setting where dysphonia would be identified managed. It intended for clinicians are likely diagnose and treat dysphonia. Purpose The primary purpose this improve care based current best evidence. Expert consensus fill evidence gaps, when used, explicitly stated supported detailed profile transparency. Specific objectives reduce inappropriate variations care, produce optimal health outcomes, minimize harm. For update, American Academy Otolaryngology-Head Neck Surgery Foundation selected panel representing fields advanced practice nursing, bronchoesophagology, consumer advocacy, family medicine, geriatric internal laryngology, neurology, otolaryngology-head neck surgery, pediatrics, professional voice, pulmonology, speech-language pathology. Action Statements update group made strong following key action statements (KASs): (1) Clinicians should assess patient history physical examination identify factors expedited laryngeal evaluation indicated. These include, but not limited to, recent surgical procedures involving head, neck, chest; endotracheal intubation; presence concomitant mass; respiratory distress stridor; tobacco abuse; whether voice user. (2) advocate therapy from cause amenable therapy. KASs: reduces life (QOL). underlying causes modify management. (3) perform laryngoscopy, refer clinician can fails resolve within 4 weeks irrespective duration if serious suspected. (4) diagnostic before prescribing document/communicate results pathologist (SLP). (5) surgery as therapeutic option conditions intervention, such suspected malignancy, symptomatic benign fold lesions do respond conservative management, glottic insufficiency. (6) offer, botulinum toxin injections treatment caused spasmodic other types dystonia. (7) inform about control/preventive measures. (8) document resolution, improvement worsened symptoms change QOL after observation. recommendation against 1 action: routinely prescribe antibiotics actions: obtain computed tomography (CT) magnetic resonance imaging (MRI) complaint prior visualization larynx. antireflux medications isolated alone attributed gastroesophageal reflux disease (GERD) laryngopharyngeal (LPR), without corticosteroids policy level laryngoscopy any time was an option: may Disclaimer clinical exhaustive source guidance managing (hoarseness). Rather, it designed assist providing framework decision-making strategies. replace judgment establish protocol individuals condition, provide only appropriate approach diagnosing problem. Differences Prior Guideline Incorporation new profiles include role preferences, confidence evidence, differences opinion, opportunities, exclusion statement does apply Inclusion 3 guidelines, 16 systematic reviews, randomized controlled trials Changes 9 KASs original New KAS (escalation care) 13 (outcomes) Addition algorithm outlining