Hoarseness and Laryngopharyngeal Reflux: a Survey of Primary Care Physician Practice Patterns

Importance: Current 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.

Objective: To examine how PCPs manage patients with dysphonia, especially with regard to laryngopharyngeal reflux.

Design, Setting, And Participants: Prospective, questionnaire-based study by an academic laryngology practice among academic PCPs from all major US geographic regions.

Main Outcomes And Measures: A 16-question web-based survey, distributed via e-mail, concerning management and possible empirical treatment options for patients with dysphonia.

Results: Of 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 Relevance: Most 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.