{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:23:30Z","timestamp":1772828610994,"version":"3.50.1"},"reference-count":23,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2018,2,20]],"date-time":"2018-02-20T00:00:00Z","timestamp":1519084800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Dysphonia is commonly encountered by primary care physicians and general otolaryngologists. We examine practice patterns of referring physicians to a tertiary voice clinic, including adherence to evidence\u2010based guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective case series with chart review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Academic tertiary care hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Subjects and Methods<\/jats:title><jats:p>In total, 821 charts of patients with voice complaints seen at a tertiary voice clinic between January 2011 and June 2016 were reviewed. Included charts (n = 755) were reviewed for type of referring provider, prior diagnoses, and treatments employed by referring physicians. Additional information regarding findings at the time of laryngoscopy\/stroboscopy and diagnoses provided by a laryngologist were also obtained. Statistical analysis was performed to determine significant relationships between variables of interest.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 244 patients (32.2%) received a diagnosis prior to evaluation in the voice clinic, most commonly laryngopharyngeal reflux disease (n = 134). Prior medical treatment was attempted in 221 (29.3%) patients, typically antireflux medications (n = 141). Of the patients treated with proton pump inhibitors by referring physicians, 65.1% lacked symptoms of gastroesophageal reflux disease. Patients with prior treatment had a median duration of symptoms 6 weeks longer than those without prior treatment (<jats:italic>P<\/jats:italic> =. 04). Among previously diagnosed patients, 199 (81.6%) of diagnoses changed after evaluation in the voice clinic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Referring physicians frequently treat dysphonic patients empirically, often with antireflux medications. Subspecialist evaluation results in changes in diagnosis in many patients. Empiric treatment can delay referral and appropriate treatment.<\/jats:p><\/jats:sec>","DOI":"10.1177\/0194599818758958","type":"journal-article","created":{"date-parts":[[2018,2,20]],"date-time":"2018-02-20T19:15:04Z","timestamp":1519154104000},"page":"1072-1078","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Practice Patterns of Referring Physicians in Management of the Dysphonic Patient"],"prefix":"10.1002","volume":"158","author":[{"given":"Andrew J.","family":"Holcomb","sequence":"first","affiliation":[{"name":"University of Kansas Medical Center Kansas City Kansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chelsea S.","family":"Hamill","sequence":"additional","affiliation":[{"name":"Case Western Reserve Medical Center Cleveland Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Irwin","sequence":"additional","affiliation":[{"name":"University of Kansas School of Medicine Kansas City Kansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Sykes","sequence":"additional","affiliation":[{"name":"University of Kansas Medical Center Kansas City Kansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James D.","family":"Garnett","sequence":"additional","affiliation":[{"name":"University of Kansas Medical Center Kansas City Kansas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shannon","family":"Kraft","sequence":"additional","affiliation":[{"name":"University of Kansas Medical Center Kansas City Kansas 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