Laryngologist Lee Akst shares an overview of his expert lecture, given at the AAO–HNSF virtual annual meeting, about the importance of a broad differential diagnosis for patients presenting with hoarseness and dysphonia. He outlines the components of an evidence-based approach and encourages practitioners to think beyond a diagnosis of reflux.
Hello, I'm Dr Lee Acts from the Johns Hopkins Voice Center. I'm director of Learn Geology, Johns Hopkins and I'm here today to provide a recap of my American Academy of Otolaryngology course on all That's Red. Isn't Re Floods getting smarter about LPR? The Hoarseness edition. This is a course that in its most recent iteration, focusing on Leon hoarseness and evaluation of dystonia that I've been privileged to give with Dr Tom Carroll from Brigham and Women's Hospital. In years past, we've had a two hour seminar devoted to all things reflux and all things Lauren go fair and geo reflux. Talking about differential diagnosis and what to do when it's not reflects in this hoarseness edition, we really focus in on the complaint of dysphonia, the signs and symptoms that might suspect or lead you to suspect that it's reflux related and what else to think about because, unfortunately, we know that there's a lot of dystonia that presents on the basis of things like Charissis, muscle tension, dysphonia, subtle vocal cords, scar that is not caused by reflux. That's not going to get better with antacid medicine alone, but which is perhaps under appreciated absent stra Bosc a B and absent a broader recognition that not all that's red is reflux. So in this course we provide an evidence based approach toe looking at your patient with this Sonia, we tried to discourage you from putting a scope in and saying, It's a little bit red. It's a little bit air clematis. It's a little of them. It is. It must be reflects, because we know that physical exam in an evidence based world. Our flexible Ringo fair and gossipy results cannot diagnose reflux. They can rule out other lesions, okay, but they don't diagnose reflux. We certainly encourage you to try empirical reflux treatment. Do it, however, as a tri ALS. If the patient has heartburn, all of our academy guidelines Ingi Academy guidelines would support an impaired trial of reflux medication. But if the patients not getting better on antacid, we encourage a broader differential diagnosis that emphasizes the role of stra Bosc. Api. Looking for Parisse is for muscle tension, dysphonia for subtle scar for other phone natori abnormalities or causes of their dystonia rather than reflux. The practice we want to discourage is the focus on reflux as the Onley diagnosis, where you go from daily P p I to be I d p p i to a referral to G I for hoarseness That's not responding to antacid medicine when it was never actually caused by reflects in the first place. If the appropriate evaluation and work up of patients with dysphonia as it relates specifically to reflux is interesting to you, I encourage you to download the course. It's available to you on the Academy website. Thank you very much.
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