From the Guidelines
The best initial workup for dysphonia should begin with a comprehensive history and physical examination, focusing on the voice complaint, duration, associated symptoms, and risk factors, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery Foundation 1. The history should include questions about voice use patterns, occupation, smoking history, reflux symptoms, and recent illnesses. Physical examination should include visualization of the larynx, preferably through flexible laryngoscopy performed by an otolaryngologist or speech-language pathologist, as this allows direct assessment of vocal fold structure and function 1. Additional components of the initial workup may include:
- A voice evaluation by a speech-language pathologist to document voice quality
- Stroboscopy to evaluate vocal fold vibration patterns
- Screening for potential contributing factors such as allergies, reflux, or thyroid dysfunction Laboratory tests are not routinely needed unless specific conditions are suspected, and imaging studies like CT or MRI are generally reserved for cases with concerning findings on laryngoscopy or persistent symptoms despite treatment, as stated in the clinical practice guideline 1. This comprehensive approach is recommended because dysphonia can result from various causes, including vocal fold lesions, neurological disorders, inflammatory conditions, or functional issues, and proper diagnosis requires direct visualization of the larynx combined with thorough history and functional assessment. It is also important to note that clinicians should not obtain computed tomography (CT) or magnetic resonance imaging (MRI) for patients with a primary voice complaint prior to visualization of the larynx, and should not prescribe antireflux medications or corticosteroids without visualization of the larynx, as recommended by the guideline 1. Furthermore, clinicians should perform diagnostic laryngoscopy, or refer to a clinician who can perform diagnostic laryngoscopy, before prescribing voice therapy, and should advocate voice therapy for patients with dysphonia from a cause amenable to voice therapy, as stated in the guideline 1. Overall, the initial workup for dysphonia should prioritize a comprehensive history, physical examination, and visualization of the larynx, with additional testing and treatment guided by the results of these initial evaluations.
From the Research
Initial Workup for Dysphonia
The best initial workup for dysphonia (not yet diagnosed) involves a comprehensive medical and vocal history, as well as visualization of the vocal cords to rule out potential malignant lesions 2, 3.
- Medical and Vocal History: A complete medical and vocal history is essential in the evaluation of dysphonia, including the history of present illness, past medical history, past surgical history, review of systems, medications, and social history 2.
- Visualization of Vocal Cords: Visualization of the vocal cords is crucial in the diagnostic approach to chronic laryngitis to rule out potential malignant lesions 3.
- Laryngoscopy: Laryngoscopy serves an important role in the diagnosis of spasmodic dysphonia by excluding other pathologic causes and identifying vocal tremor 4.
- Treatment Approaches: Various treatment approaches are used for adult dysphonic patients, including proton pump inhibitor (PPI), referral to speech pathology, and stroboscopy 5.
Diagnostic Tools
Diagnostic tools such as videolaryngoscopy and voice spectrography can be used to confirm the efficacy of botulinum toxin injections in the treatment of spasmodic dysphonia 6.
- Videolaryngoscopy: Videolaryngoscopy can be used to visualize the vocal cords and confirm the absence of spasm in patients with adductor spasmodic dysphonia 6.
- Voice Spectrography: Voice spectrography can be used to assess vocal improvement and response to treatment in patients with spasmodic dysphonia 6.