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Scientific Oral Presentations

Laryngology/Broncho-Esophagology

Session: Scientific Oral Presentation 4 - Laryngology/Broncho-Esophagology

Adherence to Clinical Practice Guidelines: Hoarseness

Tuesday, October 14, 2025
9:54 AM - 10:00 AM EDT
Location: 120
Disclosure(s):
Emily N. Milarachi, MD, MSCI:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Jeffrey Lorenz, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Clinical practice guidelines seek to improve patient outcomes with standardized, evidence-based recommendations, however the direct impact and efficacy of these publications is unclear. This study seeks to evaluate patients with new dysphonia diagnoses in order to compare work-up and treatment of patients both before and after publication of the 2018 American Academy of Otolaryngology- Head and Neck Surgery guidelines for hoarseness.

Methods: This retrospective cohort study uses TriNetX, a de-identified healthcare database, to evaluate patients with a new dysphonia diagnosis between January 1, 2018 and December 31, 2023. This study was conducted in January 2025. Percentages of patients undergoing work-up and treatment for dysphonia were evaluated compared to before and after publication of most recent guidelines in March 2018. Key measures include recommendations for diagnostic laryngoscopy performed within 4 weeks, voice therapy after visualization, and surgery when able, with recommendations against imaging and medication therapies for isolated dysphonia. Descriptive statistics and student's t-test were used for statistical analysis between the cohorts.

Results: Our total cohort includes 566,203 patients with a new dysphonia diagnosis between January 2013 to December 2023 in the TriNetX database. Time to laryngoscopy after diagnosis do not show significant difference between the cohorts with 75,028 (36.0%) patients undergoing a scope within 4 weeks in the pre-publication cohort compared to 140,973 (35.6%) after publication of the guidelines. Further analysis showed 83,200 (39.9%) of the pre-publication cohort had a scope exam within 3 months, consistent with the prior 2009 guidelines, compared to 157,886 (35.7%) of patients in the post-guideline cohort.

Conclusions: Clinical guidelines provide a central and reliable source of information for otolaryngologists as well as primary care providers, but adherence to these guidelines is critical for patient care. Further efforts to promote dissemination of these guidelines may be necessary to achieve better adherence.

    Presenting Author(s)

  • Emily N. Milarachi, MD, MSCI

    Resident, PGY 4
    Penn State Health Hershey Medical Center
    Hershey, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Bao Y. Sciscent, MD

    Resident
    Department of Otolaryngology- Head and Neck Surgery, University of Virginia
    Charlottesville, VA, United States

    Disclosure information not submitted.

  • Jeffrey Lorenz, MD

    Resident
    Penn State College of Medicine, Department of Otolaryngology – Head and Neck Surgery
    Hershey, PA, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • John P. Gniady, MD, FACS

    Associate Professor, Medical Director, Chief of the Division of Communication Sciences
    Milton S. Hershey Medical Center - Dept. of Otolaryngology
    Hershey, PA, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • NG

    Neerav Goyal, MD MPH FACS

    Professor; Division Chief Head and Neck Surgery; Vice Chair Patient Safety and Quality
    Penn State Milton S Hershey Medical Center
    Hershey, Pennsylvania, United States

    Disclosure information not submitted.