Investigating current clinical practice in assessment and diagnosis of voice disorders: A cross-sectional multidisciplinary global web survey

Background: Published best-practice guidelines and standardized protocols for voice assessment recommend multidisciplinary evaluation utilizing a comprehensive range of clinical measures. Previous studies report variations in assessment practices when compared with these guidelines.

Aims: To provide an up-to-date evaluation of current global multidisciplinary practice patterns and the opinions of otolaryngologist, ear, nose and throat (ENT) and speech-language pathology (SLP) clinicians on initial assessment and differential diagnosis of adults with voice disorders (VDs).

Methods & procedures: ENTs and SLPs worldwide who had worked with VDs within the last 10 years completed an anonymous online survey. Themes explored demographic information about the clinical practice, information about diagnostic assessment pathways, clinical assessments routinely used for initial voice evaluation and clinician perceived value of clinical assessments important for diagnosis.

Outcomes & results: Patterns in the clinical practice of 88 SLPs and 21 ENTs from 18 countries with 1 to more than 25 years' experience were analysed. Clinicians provided services across a range of locations, and a range of assessment pathways was available for initial evaluation. Case history, laryngoscopy and auditory-perceptual measures were the most frequently selected assessments. Most clinicians favoured formal assessment measures for auditory-perceptual evaluation. Clinicians placed equal weighting on ENT and SLP assessment to aid diagnosis for muscle tension VDs and functional neurological voice disorders (FVDs).

Conclusions & implications: Practice patterns for initial diagnostic voice assessment are largely consistent with the currently published guidelines. Decisions for the selection of assessment tools vary according to VD classification, and assessment decisions appear to be guided by case history. Clinicians are not always following established protocols for obtaining reliable standardized measures. Further research is needed to understand the barriers to adhering to standardized protocols and to develop evidence for the use of case history in the process of VD diagnosis.

What this paper adds: What is already known on the subject Best-practice guidelines recommend a multidisciplinary and multidimensional assessment of adults with vocal symptoms. Prior uni-disciplinary survey studies have reported a divergence in clinical practice with the recommended guidelines. No previous studies have examined otolaryngologists and SLPs concurrently to investigate the multidisciplinary approach clinicians' use in a diagnostic voice assessment. What this paper adds to the existing knowledge This study highlights new insights into multidisciplinary voice evaluation practice patterns with an emphasis on diagnostic assessment from a global perspective. The findings build on prior research exploring clinical assessment pathways, service utilization and clinicians' preferences when selecting clinical tools to inform a differential diagnosis. What are the potential or actual clinical implications of this work? This paper provides insights to inform future service and resource planning to ensure the delivery of evidenced-based diagnostic assessment pathways. This study also makes recommendations for areas of future research to understand barriers to clinicians following recommended best-practice guidelines.