Diagnosis change in voice-disordered patients evaluated by primary care and/or otolaryngology: a longitudinal study.

OBJECTIVE: Accurate diagnosis of a voice disorder is an essential first step toward its appropriate treatment. We examined differences in laryngeal diagnosis over time in outpatients evaluated by primary care physicians (PCPs) and/or otolaryngologists. STUDY DESIGN AND SETTING: Retrospective analysis of data from a large, national administrative US claims database. SUBJECTS AND METHODS: Patients with laryngeal disorders based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004, to December 31, 2008, with at least 2 outpatient visits by a PCP and/or otolaryngologist and continuously enrolled for 12 months were included. The initial and final laryngeal diagnoses were tabulated. RESULTS: Of approximately 55 million individuals, 29,501 met inclusion criteria. More than half the patients in the PCP to otolaryngology group and one-third of the otolaryngology to otolaryngology group had different laryngeal diagnoses over time. Three-fourths of patients with an initial acute laryngitis diagnosis in the PCP to otolaryngology group and half of the otolaryngology to otolaryngology group had a different final laryngeal diagnosis. Of patients with a final laryngeal cancer diagnosis, one-fourth of the otolaryngology to otolaryngology group had an initial diagnosis of nonspecific dysphonia, and one-fifth of the PCP to otolaryngology group had an initial diagnosis of acute laryngitis. CONCLUSION: Differential diagnosis of voice disorders often evolves over time. The impact on treatment and health care utilization are important areas of future study.

Duke Scholars

Author Seth Morris Cohen Head and Neck Surgery & Communication Sciences