U. S. practice variations in the treatment of chronic laryngopharyngeal neuropathy

OBJECTIVES/HYPOTHESIS: To evaluate differences in evaluation and workup of laryngopharyngeal neuropathy in a population of general otolaryngologists and fellowship-trained laryngologists. STUDY DESIGN: Survey. METHODS: Members of the American Laryngological Association (ALA) and a general otolaryngologist database from the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) were surveyed. A questionnaire was e-mailed or mailed to 179 members of the ALA and 900 members from the AAO-HNS database. RESULTS: Responses were received from 43 subjects in the ALA group (24.5%) and 96 in the AAO-HNS database group (10.6%). Compared to the general otolaryngologists surveyed, ALA members were found to be more likely to practice in academics (79.6% vs. 6.6%) and to have been fellowship trained (79.5% vs. 16.5%). Among the general otolaryngologists, 44.6% reported being unfamiliar with laryngopharyngeal neuropathy compared to 0% from the ALA group (P < .0001). After accounting for the respondents unfamiliar with the condition, the general otolaryngologists reported being less comfortable in diagnosing laryngopharyngeal neuropathy (P < .0001) and were more concerned about the over-diagnosis of laryngopharyngeal reflux when compared to the ALA (P = .0030). CONCLUSION: General otolaryngologists and fellowship-trained laryngologist have several differences in the knowledge, workup, and treatment of chronic laryngopharyngeal neuropathy. This may translate to unnecessary treatments and tests for effected patients and should be addressed with further education targeting general otolaryngologists. LEVEL OF EVIDENCE: 4.