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

The Journal of the American Board of Family Medicine

Thad Wilkins²  Larry Kang¹  April Getz²  Ralph A. Gillies²  Dave Zimmerman² 

[1] Eisenhower Army Medical Center, Fort Gordon, GA (LK);Department of Family Medicine, Medical College of Georgia, Augusta (TW, RAG, AG, DZ)

关键词: Laryngoscopy;    Laryngeal Neoplasms;    Laryngopharyngeal Reflux;    Primary Health Care;   

DOI  :  10.3122/jabfm.2010.05.090186

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

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.

• Laryngoscopy
• Laryngeal Neoplasms
• Laryngopharyngeal Reflux
• Primary Health Care

In the United States in 2008, 12,250 new cases of laryngeal cancer were diagnosed, and an estimated 3,670 deaths occurred from laryngeal cancer.¹ The death rates from laryngeal cancer did not significantly change from 1990 (2.97 per 100,000) to 2004 (2.24 per 100,000). The 5-year survival rates decreased minimally, from 67% in 1975 to 64% in 2003.¹ Early diagnosis and definitive treatment is the key to increasing survival from laryngeal cancer. Currently, there are no screening guidelines for laryngeal cancer. Although a primary care series of adult smokers aged 40 years and older found a 3% prevalence of laryngeal cancer,² the prevalence of nasopharyngeal symptoms in primary care is largely unknown.

Family physicians commonly evaluate patients with nasopharyngeal complaints, eg, hoarseness, dysphagia, chronic cough, throat clearing, globus sensation, or chronic sore throat, and some of these patients may have serious conditions such as laryngeal cancer. In a primary care practice research network, the prevalence of dysphagia was 23%.³ In another primary care series, the prevalence of hoarseness was 11%. The association between gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux (LPR) is well established, and extra-esophageal symptoms, eg, hoarseness and globus sensation, improve with acid suppression.⁴ A systematic review found an increased risk of chronic cough in patients with GERD (odds ratio, 1.7; 95% CI, 1.4–2.1),⁵ and a national cross-sectional postal survey in Scotland found a 31% prevalence of sore throat.⁶

Nasolaryngoscopy is often used to exclude serious medical conditions, eg, laryngeal cancer, in patients with nasopharyngeal complaints, but this procedure is only performed by 6% of family physicians in the United States.⁷ Nasolaryngoscopy is performed in the office setting with topical anesthesia and nasal decongestants. In 1998 an initial study of nasolaryngoscopies performed by family physicians (n = 66) reported a mean examination time of 4.6 minutes, and the procedure was well tolerated by patients.⁸ In a subsequent study, 210 patients were evaluated by nasolaryngoscopies performed by family physicians; 90% of these cases resulted in changes in diagnosis or management after the procedure; however, both of these case series were published 20 years ago. In this article and in our study we define “nasolaryngoscopy” to mean a nasopharyngoscopy (endoscopy of the nose and nasopharynx) or a nasolaryngoscopy (endoscopy of the nose, nasopharynx, and larynx). The purpose of this study was to determine the common indications, findings, the rate of laryngeal cancer, and quantify the economics of nasolaryngoscopy in an urban, university-based family medicine clinic in the Southeastern United States.

【 授权许可】

Unknown   

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