Nasolaryngoscopy in a Family Medicine Clinic: Indications, Findings, and Economics

Abstract

Background: Nasopharyngeal complaints are common among patients who present to primary care. Patients with these complaints are often referred for nasolaryngoscopy evaluation to exclude serious conditions such as laryngeal cancer.Methods: This study is a retrospective case series in which 276 charts of adult outpatients who were referred for nasolaryngoscopy were reviewed. We examined patient demographics, procedure indications and findings, complications, and changes in clinical management.Results: Nasolaryngoscopy was completed in 273 (98.9%) patients (mean age, 51.3 ؎ 14.6 years; 71.4% were women). The most common indications for nasolaryngoscopy were hoarseness (51.3%), globus sensation (32.0%), and chronic cough (17.1%); the most common findings included laryngopharyngeal reflux (42.5%), chronic rhinitis (32.2%), and vocal cord lesions (13.2%). Three patients (1.1%) were diagnosed with laryngeal cancer and this diagnosis was significantly associated with a history of smoking (P ‫؍‬ .03). No major complications occurred.Conclusions: We found that nasolaryngoscopy was a safe procedure in the primary care setting, and no major complications occurred in our series. Patients who have ever smoked and complain of hoarseness are at higher risk for laryngeal cancer. An alarming 1% of patients in our series were diagnosed with laryngeal cancer. This is the first study to define the rates of laryngopharyngeal reflux, vocal cord lesions, and laryngeal cancer among primary care patients. (J Am Board Fam Med 2010;23:591-597.)

Flexible Nasopharyngolaryngoscopy for the Assessment of Upper Airway Disorders

“…Similar findings were seen in study done by Ahmad Nasratet al 6 In contrary, the problems were found to be more common in male (52.2%) in a study done by Muhammad Shafi et al 7 The most common findings in this study were LPRD which was 38.4%. Similar findings was observed in a study done by Wilkins et al 8 (42.5%), but the incidence of the pathology was low in the article published by Ahmad Nasrat et al 6 (11.4% ). GERD have upper airway symptoms without heartburn in 20-60 % of patients.…”

Delayed Otolaryngology Referral for Voice Disorders Increases Health Care Costs

“…Although nasolaryngoscopy has been evaluated in family medicine clinics, issues of diagnostic accuracy for family medicine physicians vs otolaryngologists have not been addressed. 22 Furthermore, with only 7% of family medicine physicians performing laryngoscopy, another onethird having no training, and 50% no interest in performing this procedure, laryngoscopy by an otolaryngologist is paramount for laryngeal/voice disorder patients. 23 Although our study was unable to address the appropriateness of treatment or progression of disease before otolaryngology evaluation, both issues could have affected the costs involved in evaluating and managing patients with laryngeal/voice disorders.…”

Reliability and Accuracy of Remote Fiberoptic Nasopharyngolaryngoscopy in the Pediatric Population

“…A telemedicine-based nasopharyngolaryngoscopy (tele-NPL) system has proven its utility in a variety of situations, such as for consultations in family medicine and other primary care clinics, 9 as well as for resident teaching and educational purposes during inpatient consultations. 7,8 To date, there have been no published studies validating the diagnostic accuracy of flexible fiber-optic NPL recordings.…”