ABSTRACT
OBJECTIVES: Early in the COVID-19 pandemic, outpatient visits were adapted for the virtual setting, forcing laryngologists to presume certain diagnoses without the aid of laryngoscopy, solely based on history and the limited physical exam available via video visit. This study aims to examine the accuracy of presumptive diagnoses made via telemedicine, compared to subsequent in-person follow up, where endoscopic examination could confirm or refute suspected diagnoses. METHODS: A retrospective chart review was conducted of 38 patients evaluated for voice-related issues at NYU Langone Health and the University of California-San Francisco. Presumptive diagnoses at the initial telemedicine encounter were noted, along with diagnostic cues used for clinical reasoning and recommended treatment plans. These presumptive diagnoses were compared to diagnoses and plans established following laryngoscopy at follow-up in-person visits. RESULTS: After laryngoscopy at the first in-person visit, 38% of presumptive diagnoses changed, as did 37% of treatment plans. The accuracy varied among conditions. Muscle tension dysphonia and Reinke's edema were accurately diagnosed without laryngoscopy, but other conditions, including vocal fold paralysis and subglottic stenosis, were not initially suspected, relying on laryngoscopy for diagnosis. CONCLUSIONS: While some laryngologic conditions may be reasonably identified without in-person examination, laryngoscopy remains central to definitive diagnosis and treatment. Telemedicine can increase access to care, but it may provide more utility as a screening tool, triaging which patients should present more urgently for in-person laryngoscopy. LEVEL OF EVIDENCE: 4.
ABSTRACT
OBJECTIVES/HYPOTHESIS: Remote voice recording and acoustic analysis allow for comprehensive voice assessment and outcome tracking without the requirements of travel to the clinic, in-person visit, or expensive equipment. This paper delineates the process and considerations for implementing remote voice recording and acoustic analysis in a high-volume university voice clinic. STUDY DESIGN: Clinical Focus. METHODS: Acoustic voice recordings were attempted on 108 unique patients over a 6-month period using a remote voice recording phone application. Development of the clinical process including determining normative data in which to compare acoustic results, clinician training, and clinical application is described. The treating Speech Language Pathologists (SLPs) were surveyed 2 months after implementation to assess ease of application, identify challenges and assess implementation of potential solutions. RESULTS: Of 108 unique patients, 83 patients were successful in completing the process of synchronous remote acoustic voice recording in conjunction with their SLP clinician. The process of downloading the application, setting up, and obtaining voice recordings was most commonly 10-20 minutes according to the 8 SLPs surveyed. Challenges and helpful techniques were identified. CONCLUSIONS: Remote acoustic voice recordings have allowed SLPs to continue to complete a comprehensive voice evaluation in a telepractice model. Given emerging knowledge about the viability of remote voice recordings, the success in obtaining acoustic data remotely, and the accessibility of a low-cost app for SLPs makes remote voice recordings a viable option to facilitate remote clinical care and research investigation.