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
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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.
