- Design
- Retrospective single-centre cohort, before and after guideline update
- Population
- 528 adults referred to ENT for dysphonia, 2015–2022
- Primary outcome
- Adherence to referral-relevant guideline recommendations
- Effect
- Full adherence 61.7% before vs 52.5% after (p = 0.059); timely referral fell to 71.3%
This single-centre audit, published 1 September in Otolaryngology–Head and Neck Surgery, reviewed 528 adults referred to a US academic ENT department for dysphonia between 2015 and 2022, comparing referral practice before and after the 2018 update of the hoarseness guideline.
The measures were the referring doctor's steps: timely referral, avoiding imaging before laryngoscopy, avoiding empirical antireflux treatment, steroids and antibiotics, and laryngoscopy before voice therapy. After the guideline, adherence fell for timely referral (80.9% to 71.3%), avoiding imaging (100% to 96.6%) and avoiding antibiotics (95.7% to 89.7%). Full adherence to all recommendations did not improve (61.7% before, 52.5% after).
The findings show that publishing a guideline does not change referral behaviour. For the GP or physician seeing hoarseness, the practical change is simple and costs nothing: see or refer for the larynx first, then treat.
- Refer hoarseness that persists beyond four weeks, or sooner with red flags, for laryngoscopy.
- Do not order neck or chest imaging for hoarseness before the larynx has been examined.
- Do not start empirical antireflux treatment, steroids or antibiotics before laryngoscopy.
- Do not send patients for voice therapy until the vocal cords have been seen.
Why it matters
Shows that passive guideline publication did not reach the doctors who see hoarseness first.
Don't overread it
One US centre's referrals; practice elsewhere, including in India, may differ.
The statistics, in plain English
Only about half of referrals met all guideline steps after publication. The decline in some measures was statistically significant, but the study cannot say why practice changed.
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