Abstract
Background/Objectives
Growing reliance on telemedicine has created new triaging challenges. This study investigated
how effectively otolaryngology resident auditory-perceptual voice assessments performed
via telemedicine determined the need for urgent in-person clinic visits.
Methods
Twelve otolaryngology resident physicians (PGY1–PGY5) performed auditory-perceptual
assessments on 25 voice samples recorded during initial voice evaluations. Voice samples
were balanced in severity and taken in equal numbers from patients with the following
diagnoses: benign laryngeal lesions, laryngeal cancer, functional voice disorders,
laryngeal edema (associated with LPR), and laryngeal paralysis/paresis. Urgent diagnoses
were defined as laryngeal cancer and severe unilateral laryngeal paralysis. For each
voice sample, residents were initially blinded to patient medical history. Residents
rated severity of voice disorder, predicted patient diagnosis, and determined the
urgency of seeing the patient in clinic. Residents then reviewed information from
the patient's medical history and again rated urgency of voice disorder.
Results
On average, residents identified urgent voice disorders in 56% of cases. After reviewing
medical history, this number significantly increased to 77% (P = 0.001). Voice severity, smoking history, time since onset, and course of symptoms
were considered most influential when determining medical urgency of voice patients.
Year in residency program had no effect on rating accuracy. As expected, diagnostic
accuracy of auditory-perceptual assessments was low, ranging from 40% for laryngeal
paralysis/paresis to 5% for laryngeal edema.
Conclusion
Auditory-perceptual voice assessment, combined with medical history, predicted most
medically urgent voice disorders. Further work should investigate if task-specific
training might improve these results and which medical history items are most critical.
Until accuracy of auditory-perceptual assessment of medical urgency is improved, these
data underscore the importance of laryngeal examination in identifying medical urgency
and etiology of dysphonia.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of VoiceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Telemedicine in laryngology: Remote evaluation of voice disorders-setup and initial experience.Laryngoscope. 2018; 128: 941-943https://doi.org/10.1002/lary.26975
- A systematic review of the use of telehealth in speech, language and hearing sciences.J Telemed Telecare. 2015; 21: 367-376https://doi.org/10.1177/1357633X15583215
- Telehealth: voice therapy using telecommunications technology.Am J Speech Lang Pathol. 2003; 12: 432-439https://doi.org/10.1044/1058-0360(2003/089
- Telemedicine in clinical setting.Experimental and Therapeutic Medicine. 2016; 12: 2405-2407https://doi.org/10.3892/etm.2016.3656
- Improving Access to Otolaryngology–Head and Neck Surgery Expert Advice Through eConsultations.The Laryngoscope. 2018; 128: 350-355https://doi.org/10.1002/lary.26677
- Waiting Your Turn: Wait Times for Health Care in Canada. 2015 Report Vancouver.The Fraser Institute, British Columbia, Canada2016: 1-98 (Published online)
- Embracing telemedicine into your otolaryngology practice amid the COVID-19 crisis: An invited commentary.Am J Otolaryngol. 2020; : 41https://doi.org/10.1016/j.amjoto.2020.102490
- A Commentary on the Challenges of Telemedicine for Head and Neck Oncologic Patients during COVID-19.Otolaryngology - Head and Neck Surgery. 2020; 163: 81-82
- Remote management of voice and swallowing disorders.Otolaryngol Clin North Am. 2011; 44: 1305-1316https://doi.org/10.1016/j.otc.2011.08.007
- Implementation of Telemedicine in a Laryngology Practice During the COVID-19 Pandemic: Lessons Learned, Experiences Shared.Journal of Voice. 2021; (Published online In Press)https://doi.org/10.1016/j.jvoice.2020.06.017
- Evidence-based clinical voice assessment: a systematic review.American journal of speech-language pathology. 2013; 22: 212-226https://doi.org/10.1044/1058-0360(2012/12-0014
- Recommended Protocols for Instrumental Assessment of Voice: American Speech-Language-Hearing Association Expert Panel to Develop a Protocol for Instrumental Assessment of Vocal Function.American Journal of Speech-Language Pathology. 2018; 27: 887-905https://doi.org/10.1044/2018_AJSLP-17-0009
- Establishing validity of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V).American Journal of speech-language pathology. 2011; 20: 14-22https://doi.org/10.1044/1058-0360(2010/09-0105
- Perceptual evaluation of severe pediatric voice disorders: rater reliability using the Consensus Auditory-Perceptual Evaluation of Voice.Journal of Voice. 2010; 24: 441-449https://doi.org/10.1016/j.jvoice.2008.09.004
- The reliability of three perceptual evaluation scales for dysphonia.Eur Arch Oto-Rhino-L. 2004; 261: 429-434
- Perceptual evaluation of voice quality and its correlation with acoustic measurements.J Voice. 2004; 18: 299-304https://doi.org/10.1016/j.jvoice.2003.12.004
- Quantifying dysphonia severity using a spectral/cepstral-based acoustic index: Comparisons with auditory-perceptual judgements from the CAPE-V.Clin Linguist Phon. 2010; 24: 742-758
- Classification of dysphonic voices: acoustic and auditory-perceptual measures.J Voice. 2005; 19: 1-14https://doi.org/10.1016/j.jvoice.2004.02.002
- Test-Retest Study of the GRBAS Scale: Influence of Experience and Professional Background on Perceptual Rating of Voice Quality.Journal Of Voice. 1995; 11: 74-80
- The effect of perceptual training on inexperienced listeners’ judgments of dysphonic voice.J Voice. 2006; 20: 527-544https://doi.org/10.1016/j.jvoice.2005.08.007
- Listener experience and perception of voice quality.J Speech Hear Res. 1990; 33: 103-115https://doi.org/10.1044/jshr.3301.103
- The Effect of Listener Experience and Anchors on Judgments of Dysphonia.JSLHR. 2011; 54: 430-447https://doi.org/10.1044/1092-4388(2010/09-0205
- Does Knowledge of Medical Diagnosis Bias Auditory-Perceptual Judgments of Dysphonia?.Journal Of Voice. 2011; 25: 420-429https://doi.org/10.1016/j.jvoice.2009.12.009
- Does the Accuracy of Medical Diagnoses Affect Novice Listeners’ Auditory-Perceptual Judgments of Dysphonia Severity?.Journal of Voice. 2020; 34: 197-207https://doi.org/10.1016/j.jvoice.2018.08.001
- When and why listeners disagree in voice quality assessment tasks.J Acoust Soc Am. 2007; 122: 2354-2364https://doi.org/10.1121/1.2770547
- Developing Auditory-Perceptual Judgment Reliability in Otolaryngology Residents.Journal of Voice. 2012; 26: 358-364https://doi.org/10.1016/j.jvoice.2011.07.006
- Consensus auditory-perceptual evaluation of voice: development of a standardized clinical protocol.Am J Speech Lang Pathol. 2009; 18: 124-132https://doi.org/10.1044/1058-0360(2008/08-0017
- Etiologic Features in Patients with Unilateral Vocal Fold Paralysis in Taiwan.Chang Gung Med J. 2009; 32: 290-296
- Vocal Cord Paralysis and its Etiologies: A Prospective Study.J Cardiovasc Thorac Res. 2014; 6: 47-50https://doi.org/10.5681/jcvtr.2014.009
- Etiology of Vocal Cord Paralysis.ORL : Journal for Oto - Rhino - Laryngology and its Related Specialties. 2007; 69: 167-171https://doi.org/10.1159/000099226
- The inability to produce soft voice (IPSV): A tool to detect vocal change in school-teachers.Logoped Phoniatr Vocol. 2009; 34: 117-127https://doi.org/10.1080/14015430903062712
- Simple vocal tasks for detecting vocal fold swelling.J Voice. 1990; 4: 172-183https://doi.org/10.1016/S0892-1997(05)80144-4
- Comparison of Habitual and High Pitch Phonation in Teachers With and Without Vocal Fatigue.Journal of Voice. 2020; (Published online May 13)https://doi.org/10.1016/j.jvoice.2020.04.016
- Mitigating the Effects of Acute Vocal Exertion in Individuals With Vocal Fatigue.Laryngoscope. 2021; (Published online May 19)https://doi.org/10.1002/lary.29627
- Validity and reliability of the Eating Assessment Tool (EAT-10).Ann Otol Rhinol Laryngol. 2008; 117: 919-924https://doi.org/10.1177/000348940811701210
- Accuracy of Acoustic Measures of Voice via Telepractice Videoconferencing Platforms.J Speech Lang Hear Res. 2021; (Published online June 22): 1-14https://doi.org/10.1044/2021_JSLHR-20-00625
- Determining Medical Urgency of Voice Disorders Using Auditory-Perceptual Voice Assessments Performed by Speech-Language Pathologists..Annals of Otology, Rhinology & Laryngology. 2021; Published online July 20https://doi.org/10.1177/00034894211032779
Article info
Publication history
Published online: August 31, 2021
Accepted:
July 8,
2021
Publication stage
In Press Corrected ProofFootnotes
Portions of this paper were presented in poster format at the COSM, virtual ALA meeting, April 7, 2021.
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of The Voice Foundation.