Elsevier

Auris Nasus Larynx

Volume 47, Issue 1, February 2020, Pages 7-17
Auris Nasus Larynx

A summary of the Clinical Practice Guideline for the Diagnosis and Management of Voice Disorders, 2018 in Japan

https://doi.org/10.1016/j.anl.2019.09.004Get rights and content

Abstract

Objective

To develop a summary of the first version of the Clinical Practice Guideline of Voice Disorders for Diagnosis, Management, and Treatment in Japan by the Clinical Practice Guideline Committee of the Japan Society of Logopedics and Phoniatrics and The Japan Laryngological Association. The 2018 recommendations, based on a review of the scientific literature, are intended to serve as clinical practice guidelines for the diagnosis, management, and treatment of voice disorders in Japan.

Methods

A summary of the original version of the Clinical Practice Guideline of Voice Disorders for Diagnosis, Management, and Treatment in Japan was described. Recommendations for the diagnosis, management, and treatment of voice disorders were prepared. Twelve clinical questions (CQs) regarding the diagnosis, management, treatment, and effectiveness of therapy for voice disorders were also prepared.

Results

A summary of the first version of the clinical practice guidelines for the diagnosis, management, and therapy of voice disorders was prepared and is presented. Additionally, answers to the 12 CQs on the diagnosis, management, treatment, and effectiveness of voice disorder therapy were prepared, and include evidence-based recommendations.

Conclusion

These guidelines present a summary of the standard approaches for the diagnosis and treatment of voice disorders and relevant CQs that consider the medical environments in Japan. We hope that the guidelines will assist physicians in clinical settings for patients with voice disorders.

Introduction

Voice disorders have adverse effects on the physical, mental, and functional quality of life of affected patients and have a variety of causes. The diagnosis and management of voice disorders have shown significant developments over time. However, the therapies used to treat voice disorders vary according to the intentions of each doctor, speech pathologist, or institution. Consequently, clinical practice guidelines for diagnosis and management would be useful. As part of the development of these guidelines, we considered clinical questions (CQs) concerning the evaluation, examination, and therapy of voice disorders that we answer in this paper. However, the text structure does not follow that of original version. We omit some description that are present in the original. As a rule, we reviewed the papers up to 2014 and published the Japanese version of the Clinical Practice Guideline for the Diagnosis and Management of Voice Disorders, 2018. This paper is generally a summary, but minor corrections were necessary for subsequent papers regarding 5.4. and CQ3.

Section snippets

Criteria for determining recommendation grades

A summary of the CQs relevant to the evaluation, examination, and therapy of voice disorders were prepared to help develop guidelines. A comprehensive literature search of studies published through the end of 2014 was performed. Other useful literature was added as needed. The databases used were PubMed and the Japan Medical Abstract Society Web. Subsequently, three members were assigned the task of collecting scientific evidence concerning each CQ from the selected papers. After a consensus

Pre-release review

Before the publication of the Guideline, public comments were solicited from the Japan Society of Logopedics and Phoniatrics, the Japan Laryngological Society, and the Oto-Rhino-Laryngological Society of Japan. Corrections were then made where necessary.

Definition and classification of voice disorders

Voice disorders are diseases that cause dysphonia, which is defined as an altered vocal quality, pitch, loudness, or vocal effort that impairs communication and affects the quality of life as assessed by a clinician [1].

In this Guideline, voice disorders were classified based on the Classification Manual for Voice Disorders-1 [2] published by the American Speech–Language–Hearing Association with modification so as to fit the general clinical practice in Japan. The classifications of voice

Interview

To evaluate a patient with hoarseness, the following information should be obtained: type of onset (e.g., sudden, gradual), duration of dysphonia, potential inciting events, how the condition affects the patient, associated symptoms (e.g., swallowing, breathing difficulties), modifying factors, current medications, habits (e.g., smoking, alcohol use), a detailed medical history, current medical condition, and history of prior surgery. Care must be taken when interviewing children or patients

Antibiotics

Administration of antibiotic drugs is recommended for laryngitis associated with microbial infection. The dosage or period of the administration should be carefully considered to prevent the development of drug resistance or side effects [1].

Non-steroidal anti-inflammatory drugs and other anti-inflammatory drugs

Various kinds of anti-inflammatory drugs are available. For example, tranexamic acid is often administered for vocal cord hemorrhage and redness. Carbocysteine is used for the purpose of repair of airway mucous membrane and viscosity reduction of sputum.

Clinical questions

CQ-1

Are GRBAS Scales effective and useful for voice quality evaluation? (Strong Recommendation)

Vocal sounds are not only a physiological phenomenon but also a psychological one because they should be recognized by the human brain. Therefore, physical and psychological aspects of voice quality should be evaluated.

Evaluation of physical aspects includes many parameters that are useful as well as highly objective and reproductive. Even with a combination of these parameters, the voice cannot be

Conclusions

We described the standard approaches for diagnosis and treatment of voice disorders and presented relevant CQs that consider the medical environments in Japan. The intention of this guideline is not to require the therapeutic managements described here but rather to provide useful information to physicians in clinical settings. We hope that this guideline will contribute to appropriate diagnosis and treatment for patients with voice disorders.

Disclosure statement

Production of this guideline was funded by the Japan Society of Logopedics and Phoniatrics and the Japan Laryngological Association. None of the members of the guideline committee has received any personal financial support from related companies or organizations.

Ethical statement

  • 1)

    This material is the authors’ own original work, which has not been previously published elsewhere.

  • 2)

    The paper is not currently being considered for publication elsewhere.

  • 3)

    The paper reflects the authors’ own research and analysis in a truthful and complete manner.

  • 4)

    The paper properly credits the meaningful contributions of co-authors and co-researchers.

  • 5)

    The results are appropriately placed in the context of prior and existing research.

  • 6)

    All sources used are properly disclosed (correct citation).

Acknowledgements

A summary of the Clinical Practice Guideline for the Diagnosis and Management of Voice Disorders, 2018 in Japan was revised by the members of the Subcommittee of Clinical Practice Guidelines for diagnosis and management of voice disorder 2018 composed by the Japan Society of Logopedics and Phoniatrics, the Japan Laryngological Society and evaluated by the Oto-Rhino-Laryngological Society of Japan. The authors would like to thank Dr. Seiji Niimi, Dr. Hajime Hirose, and Dr. Eiji Yumoto for

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