Clinical criteria for evidence-based treatment of laryngitis and benign laryngeal neoplasms

Pedersen, Mette and Barney, Anna (2010) Clinical criteria for evidence-based treatment of laryngitis and benign laryngeal neoplasms. 9th International Conference on Advances in Quantitative Laryngology, Voice and Speech Research, Erlangen, Germany. 09 - 10 Sep 2010.

Abstract

Introduction: In a European Position Paper (EPP), Fokkens et al (1) have considered the evidence based literature on mucosal function in rhinosinusitis and nasal polyps (as parts of the upper airways). An attempt has been made to do the same in laryngology.

Method: The search method in the literature includes: A definition of disorders and thereafter a description of: Epidemiology and predisposing factors. Inflammatory mechanisms in acute and chronic disorders. Bases for diagnoses including acoustical evaluation. Considerations for management. Special consideration in children. Relation to lower airways. Socio-economic costs. Outcome measures in evidence based research. Needs and priorities.

Results of preliminary search of literature:
1. Acoustical analyses of the voice: Acoustical analyses compared with listeners tests were evaluated in a statistical meta-analysis (2) with the conclusion that caution is warranted regarding the concurrent validity of measures. The clinical utility of many measures commonly used to analyse sustained tones as well as continuous speech were not found to be sufficiently evidence based for inclusion in the referred analysis.
2. Singers and speakers: In singers, a review was made of definitions and treatment of disorders (3). No evidence based studies have been found. Ulis and Yanagisawa (4) report a lack of large, controlled, prospective studies regarding diagnosis and management of dysphonic patients. They note, however, that high-speed digital imaging is gradually becoming a useful adjunct to stroboscopy in patients with hoarseness and aperiodicity.
3. Swallowing and respiration: Based on a Cochrane review it was shown that the swallowing process in the throat was not related to deficiency of voice function in the larynx in an evidence based way (6). Following a systematic literature review, Syed et al. (5) report that laryngopharyngeal reflux is cited as a cause of hoarseness but the evidence base for treatment with gastric acid suppression is poor.
4. Surgery: To date, no analysis of outcomes of surgery on the vocal cords has been made using the Cochrane classification of statistical evidence. This means that there is no evidence on surgery of the vocal cords in benign disorders.

Discussion: Based on our search suggestions are made of chapters of areas where it is important to search scientific literature for evidence very carefully, especially randomized control trials (RCT), as it has been done in rhinology.

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Contributors

Author: Anna Barney

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