• Ryan Ruiz, Seema Jeswani, Kenneth Andrews, Benjamin Rafii, Benjamin C Paul, Ryan C Branski, and Milan R Amin.
• Department of Otolaryngology-Head and Neck Surgery, NYU Voice Center, New York University School of Medicine, New York, New York.
• JAMA Otolaryngol Head Neck Surg. 2014 Mar 1;140(3):192-6.

ImportanceCurrent approaches to the diagnosis and subsequent management of specific voice disorders vary widely among primary care physicians (PCPs). In addition, sparse literature describes current primary care practice patterns concerning empirical treatment for vocal disorders.ObjectiveTo examine how PCPs manage patients with dysphonia, especially with regard to laryngopharyngeal reflux.Design, Setting, And ParticipantsProspective, questionnaire-based study by an academic laryngology practice among academic PCPs from all major US geographic regions.Main Outcomes And MeasuresA 16-question web-based survey, distributed via e-mail, concerning management and possible empirical treatment options for patients with dysphonia.ResultsOf 2441 physicians who received the e-mail broadcast, 314 (12.9%) completed the survey. Among those who completed the survey, 46.3% were family practitioners, 46.5% were trained in internal medicine, and 7.2% identified as specialists. Among all respondents, 64.0% preferred to treat rather than immediately refer a patient with chronic hoarseness (symptoms persisting for >6 weeks) of unclear origin. Reflux medication (85.8%) and antihistamines (54.2%) were the most commonly selected choices for empirical treatment. Most physician respondents (79.2%) reported that they would treat chronic hoarseness with reflux medication in a patient without evidence of gastroesophageal reflux disease.Conclusions And RelevanceMost PCPs who responded to our survey report empirically treating patients with chronic hoarseness of unknown origin. Many physician respondents were willing to empirically prescribe reflux medication as primary therapy, even when symptoms of gastroesophageal reflux disease were not present. These data suggest that PCPs strongly consider reflux a common cause of dysphonia and may empirically treat patients having dysphonia with reflux medication before referral.

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