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Background: Published best-practice guidelines and standardized protocols for voice assessment recommend multidisciplinary evaluation utilizing a comprehensive range of clinical measures. Previous studies report variations in assessment practices when compared with these guidelines., Aims: To provide an up-to-date evaluation of current global multidisciplinary practice patterns and the opinions of otolaryngologist, ear, nose and throat (ENT) and speech-language pathology (SLP) clinicians on initial assessment and differential diagnosis of adults with voice disorders (VDs)., Methods & Procedures: ENTs and SLPs worldwide who had worked with VDs within the last 10 years completed an anonymous online survey. Themes explored demographic information about the clinical practice, information about diagnostic assessment pathways, clinical assessments routinely used for initial voice evaluation and clinician perceived value of clinical assessments important for diagnosis., Outcomes & Results: Patterns in the clinical practice of 88 SLPs and 21 ENTs from 18 countries with 1 to more than 25 years' experience were analysed. Clinicians provided services across a range of locations, and a range of assessment pathways was available for initial evaluation. Case history, laryngoscopy and auditory-perceptual measures were the most frequently selected assessments. Most clinicians favoured formal assessment measures for auditory-perceptual evaluation. Clinicians placed equal weighting on ENT and SLP assessment to aid diagnosis for muscle tension VDs and functional neurological voice disorders (FVDs)., Conclusions & Implications: Practice patterns for initial diagnostic voice assessment are largely consistent with the currently published guidelines. Decisions for the selection of assessment tools vary according to VD classification, and assessment decisions appear to be guided by case history. Clinicians are not always following established protocols for obtaining reliable standardized measures. Further research is needed to understand the barriers to adhering to standardized protocols and to develop evidence for the use of case history in the process of VD diagnosis., What This Paper Adds: What is already known on the subject Best-practice guidelines recommend a multidisciplinary and multidimensional assessment of adults with vocal symptoms. Prior uni-disciplinary survey studies have reported a divergence in clinical practice with the recommended guidelines. No previous studies have examined otolaryngologists and SLPs concurrently to investigate the multidisciplinary approach clinicians' use in a diagnostic voice assessment. What this paper adds to the existing knowledge This study highlights new insights into multidisciplinary voice evaluation practice patterns with an emphasis on diagnostic assessment from a global perspective. The findings build on prior research exploring clinical assessment pathways, service utilization and clinicians' preferences when selecting clinical tools to inform a differential diagnosis. What are the potential or actual clinical implications of this work? This paper provides insights to inform future service and resource planning to ensure the delivery of evidenced-based diagnostic assessment pathways. This study also makes recommendations for areas of future research to understand barriers to clinicians following recommended best-practice guidelines., (© 2024 The Author(s). International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Background: Dizziness and vertigo are common referrals to Ear Nose Throat (ENT) outpatient services however these services have long waitlists for assessment. Primary contact physiotherapy-led vestibular clinics are recognized as improving access to care. This pilot study investigated agreement between physiotherapists and an ENT medical practitioner for diagnostic and management decisions in patients attending a primary contact physiotherapy-led vestibular clinic., Methods: Prospective blinded inter-rater agreement study undertaken in an ENT primary contact physiotherapy-led vestibular clinic. Participants were adults referred to ENT from general practitioners, triaged (Category 2 or 3) to the primary contact physiotherapy-led vestibular clinic with clinical symptoms consistent with vestibular disorder. Primary outcome measures included agreement of diagnoses and management decisions made by an ENT medical practitioner and Physiotherapist based on a vestibular physiotherapy assessment. Adverse events were reviewed 11 months post data collection. Gwet's first order agreement co-efficient (AC1) calculated inter-rater reliability between physiotherapy and ENT., Results: Fifty-one participants were recruited consecutively from the primary contact physiotherapy-led vestibular clinic. Physiotherapy and ENT had a substantial agreement (AC1 0.613) on diagnosis. AC1 between physiotherapy and ENT for recommending Magnetic resonance imaging (0.810) and computerized tomography (0.935) both indicated near perfect agreement. There was moderate to near-perfect agreement regarding management recommendations between physiotherapy and ENT. Substantial agreement (AC1 0.720) was found for recommendations for ENT input, near perfect agreement (AC1 0.933) for neurology input and moderate agreement (AC1 0.574) for physiotherapy input. There were no adverse events from physiotherapist's management decision, based on final recommendations undertaken 11-months post data collection., Conclusions: Physiotherapists and ENT medical practitioner made comparable diagnostic and management decisions, based on physiotherapy and audiology hearing assessment, for adults with signs of vestibular dysfunction, within an ENT primary contact physiotherapy-led vestibular clinic. This study provides support for this type of Physiotherapy-led service in managing patients referred to an ENT service with vestibular dysfunction., (© 2024. The Author(s).)

Background: A challenge for clinicians and researchers in laryngology is a lack of international consensus for an agreed framework to classify homogenous groups of voice disorders. Consistency in terminology and agreement in how conditions are classified will provide greater clarity for clinicians and researchers., Objective: This scoping review aimed to examine the published literature on frameworks, terminology, and criteria for the classification of voice disorders., Design: Seven online databases (MEDLINE, Embase, CINAHL, PsycInfo, Scopus, Cochrane Collaboration, Web of Science) and grey literature sources were searched. Studies published from 1940 to 2021 were included if they provided a descriptive detail of a classification framework structure and described the methodological approaches to determine classification. A narrative synthesis of the main concepts including terminology, classification criteria, grouping of conditions, critical appraisal items and gaps in research was undertaken., Results: A total of 2,675 publications were screened. Twenty sources met inclusion criteria, including published articles and grey literature. Thirty-five classification groups and over 150 sub-groups were described. The classification group labels, and criteria for inclusion of conditions varied across the frameworks. Several key themes in terminology and criteria useful for classification are discussed, and a core set of suggested terms and definitions are presented., Conclusions: The quality of research on classification frameworks for voice disorders is low and not one system encompasses all voice disorders across the whole spectrum. Continued high quality research using consensus methodology and inter-rater reliability scores is recommended to develop and test an internationally agreed classification framework for voice disorders., Competing Interests: Declarations of competing interest None, (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: SARS-CoV-2, a highly contagious severe acute respiratory syndrome, has spread to most countries in the world and resulted in a change to practice patterns for the assessment and diagnosis of people with voice disorders. Many services are transitioning to telehealth models to maintain physical distancing measures and conserve personal protective equipment used by healthcare workers during laryngoscopy examinations. The speech-language pathology primary contact (SLPPC) assessment for patients referred to ear, nose and throat (ENT) services in Australia has been shown to reduce waiting times for assessment while streamlining access to ENT assessment and allied health practitioner treatment pathways., Methods and Analysis: A prospective observational cohort study will see patients in a newly developed telehealth model which uses the principles from a usual care SLPPC assessment protocol. Participants will be offered an initial telehealth assessment (speech-language pathology primary contact telehealth (SLPPC-T)) prior to being prioritised for a face-to-face laryngoscopy assessment to complete the diagnostic process. The telehealth assessment will collect sociodemographic information, personal and family medical history, key symptoms, onset and variability of symptoms, red-flag signs or symptoms for laryngeal malignancy, and clinical voice assessment data for auditory-perceptual and acoustic analysis. The study outcomes include (1) association of signs, symptoms and specific voice measures collected during SLPPC-T with voice disorder classification provided after laryngoscopy; (2) degree of concordance between voice disorder classification after SLPPC-T and after laryngoscopy; (3) health service and patient-related costs and health outcomes of the SLPPC-T; (4) patient and stakeholder views and beliefs about the SLPPC-T process., Ethics and Dissemination: Ethical approval has been granted prior to commencement of the study enrolment by the Gold Coast Hospital and Health Service Human Research Ethics Committee (reference number HREC/2020/QGC/62832). Results will be shared through the publication of articles in peer-reviewed medical journals and presentation at national and international scientific meetings., Trial Registration Number: ACTRN12621000427875., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: This review aims to examine the literature on the terminology and descriptions for the broad classification of voice disorders, and outline the criteria described to guide clinicians in differential classification., Introduction: The process of classifying the etiology of voice disorders is complex. A key challenge for clinicians and researchers is a lack of consensus on agreed terminology to define umbrella terms commonly used in the published literature. Consistency in the terminology for voice disorder classification, and well-defined conditions within those groups, will provide greater clarity for clinicians and researchers., Inclusion Criteria: Published and unpublished literature that include participants (adults and children) diagnosed with a voice disorder using any criteria or framework will be considered. Studies will be included provided they give a descriptive detail of the structure of the classification system and describe a methodological approach to determine classification criteria. Studies will be excluded if they include animal models or participants with alaryngeal speech, elective mutism, or resonance disorders., Methods: The following databases will be searched: MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Cochrane Database of Systematic Reviews, and Web of Science. Studies will be limited to those published in English from 1940 to present. Two independent reviewers will screen the retrieved articles against the eligibility criteria. A narrative synthesis of the main concepts will include classification terminology, classification criteria, commonly described specific diagnoses within the groups, test measures used to determine criteria, critical appraisal items, and gaps in research., Competing Interests: The authors declare no conflict of interest., (Copyright © 2021 JBI.)

Background: Traditionally, patients are seen by an ear, nose and throat (ENT) surgeon prior to allied health referral for treatment of swallowing, voice, hearing and dizziness. Wait-times for ENT consultations often exceed those clinically recommended. We evaluated the service impact of five allied health primary contact clinics (AHPC-ENT) on wait-times and access to treatment., Setting: A metropolitan Australian University Hospital Outpatient ENT Department., Participants: We created five AHPC-ENT pathways (dysphonia, dysphagia, vestibular, adult and paediatric audiology) for low-acuity patients referred to ENT with symptoms of dysphonia, dysphagia, dizziness and hearing loss., Main Outcome Measures: Using multiple regression analysis, we compared waiting times in the 24-month pre- and 12-month post-implementation of the AHPC-ENT service. In addition, we measured the number of patients requiring specialist ENT intervention after assessment in the AHPC-ENT, adverse events and evaluation of service delivery costs., Results: Seven hundred and thirty-eight patients were seen in the AHPC-ENT over the first 12 months of implementation (dysphagia, 66; dysphonia, 153; vestibular, 151; retro-cochlear, 60; and paediatric glue ear, 308). All pathways significantly reduced the waiting times for patients by an average of 277 days, compared with usual care. The majority of patients were able to be discharged without ongoing ENT intervention (72% dysphagia; 81% dysphonia; 74% vestibular; 53% retro-cochlear; and 32% paediatric glue ear). No adverse events were recorded., Conclusions: The AHPC-ENT improved waiting times for assessment and access to treatment. Future research on cost-effectiveness and diagnostic agreement between AHPs and ENT clinicians would provide further confidence in the model., (© 2020 John Wiley & Sons Ltd.)

Objectives: To develop and validate a laryngectomee-specific questionnaire to investigate swallowing function. This paper describes the generation of questionnaire items, pretesting with laryngectomees and a preliminary validation., Design: This study employed 2 phases: questionnaire development and questionnaire validation. Items were developed from patient (n = 10) and clinician (n = 6) focus groups. Content checking, acceptability and face validity were determined through pretesting with 10 laryngectomees and via consensus feedback from 35 speech and language therapists. During preliminary validation, the 17-item final questionnaire was administered to 3 different groups. Discrimination amongst groups was established by comparing questionnaire responses of a laryngectomee group (n = 19) with known dysphagic (n = 19) and non-dysphagic groups (n = 20). Questionnaire responses from the reference dysphagic group were compared with an instrumental assessment of swallowing, the modified barium swallow (MBS)., Setting: Large urban teaching hospital., Participants: Speech and language therapists, laryngectomees, non-dysphagic volunteers, post-radiotherapy dysphagic patients., Main Outcome Measure: Preliminary validation of SOAL questionnaire., Results: Normal, laryngectomee and dysphagic groups had significantly different SOAL scores, as did laryngectomees with different degrees of swallowing impairment (Kruskall Wallis, P << 0.001). The subjective SOAL score had a strong positive correlation with the reference measure of ratings on the MBS (r = 0.5; P = 0.03)., Conclusions: The swallowing outcome after laryngectomy (SOAL) questionnaire is a simple, self-administered tool to assess swallowing function post-total laryngectomy. Further specific testing with a laryngectomy cohort is necessary for full validation. Its potential value lies in screening for dysphagia in clinics or during long-term follow-up of laryngectomees., (© 2012 Blackwell Publishing Ltd.)