{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T11:20:35Z","timestamp":1788261635119,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Evaluate referring physicians' adherence to the 2018 Hoarseness\/Dysphonia Clinical Practice Guideline when referring to an academic otolaryngology department.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Tertiary academic medical center.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Adult patients (\u2265\u200918 years old) referred to the University of Missouri Department of Otolaryngology\u2013Head and Neck Surgery for a primary complaint of dysphonia between January 2015 and December 2022 were included. Patients referred from otolaryngologists or primary complaints other than dysphonia were excluded. Demographics, diagnoses, referral reason, and prior management were assessed. Referral practices before and after the 2018 update were examined across recommendations relevant to referring physicians: timely referral, avoidance of pre\u2010laryngoscopy imaging, avoidance of empiric antireflux therapy, corticosteroids, and antibiotics, and performance of laryngoscopy before prescribing voice therapy. Adherence to each recommendation and all recommendations combined was compared between pre\u2010 and post\u2010guideline cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In all, 528 patients were included: 141 (26.7%) were referred before and 387 (73.3%) after the 2018 update. Following guideline publication, adherence significantly\n                      <jats:italic>decreased<\/jats:italic>\n                      for timely referral (71.3% vs 80.9%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.027), avoidance of imaging (96.6% vs 100%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.028), and avoidance of antibiotics (89.7% vs 95.7%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.028). No significant changes were observed for antireflux therapy, corticosteroid use, or referral before prescribing voice therapy. Adherence to all analyzed guidelines did not improve (52.5% vs 61.7%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.059).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Referral patterns to otolaryngology physicians for dysphonia do not reflect high fidelity to updated clinical practice guidelines. These findings underscore the limitations of passive dissemination and the need for targeted implementation strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ohn.70383","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T11:08:52Z","timestamp":1788260932000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating Dysphonia Referrals to Otolaryngology Providers: Is There a Need For Improved Referral Guideline Implementation?"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2012-7135","authenticated-orcid":false,"given":"Rishi","family":"Kondapaneni","sequence":"first","affiliation":[{"name":"School of Medicine University of Missouri Columbia Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlyn","family":"Florence","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Otolaryngology\u2013Head &amp; Neck Surgery University of Missouri Columbia Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Shock","sequence":"additional","affiliation":[{"name":"School of Medicine University of Missouri Columbia Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Henry","sequence":"additional","affiliation":[{"name":"School of Medicine University of Missouri Columbia Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Price","sequence":"additional","affiliation":[{"name":"School of Medicine University of Missouri Columbia Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Logan","family":"Mays","sequence":"additional","affiliation":[{"name":"School of Medicine University of Missouri Columbia Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Bodeen","sequence":"additional","affiliation":[{"name":"School of Medicine University of Missouri Columbia Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Ge","sequence":"additional","affiliation":[{"name":"School of Medicine, Department of Biomedical Informatics, Biostatistics, and Medical Epidemiology University of Missouri Columbia Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4251-1400","authenticated-orcid":false,"given":"Mark R.","family":"Gilbert","sequence":"additional","affiliation":[{"name":"College of Medicine, Department of Otolaryngology\u2010Head and Neck Surgery University of Illinois Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"issue":"2","key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1002\/lary.22426","article-title":"Prevalence and causes of dysphonia in a large treatment\u2010seeking population","volume":"122","author":"Cohen SM","year":"2012","journal-title":"Laryngoscope"},{"key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"1988","DOI":"10.1097\/01.mlg.0000179174.32345.41","article-title":"Voice disorders in the general population: prevalence, risk factors, and occupational impact","volume":"115","author":"Roy N","year":"2005","journal-title":"Laryngoscope"},{"issue":"3","key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.otohns.2009.06.744","article-title":"Clinical practice guideline: hoarseness (dysphonia)","volume":"141","author":"Schwartz SR","year":"2009","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"1","key":"e_1_2_9_5_1","first-page":"1","article-title":"Clinical practice guideline: hoarseness (dysphonia) (update)","volume":"158","author":"Stachler RJ","year":"2018","journal-title":"Otolaryngol Head Neck Surg"},{"key":"e_1_2_9_6_1","volume-title":"StatPearls","author":"Neighbors C","year":"2024"},{"key":"e_1_2_9_7_1","unstructured":"BruchJM KamaniDVHoarseness in adults. 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