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INTRODUCTION

The purpose of a clinical voice evaluation is to provide the referring laryngologist with patient-specific, clinically relevant pathophysiologic information of the actual voice production process generated by the dysphonic patient, the nature of the dysphonic sound, and the physiologic conditions responsible for the sound production. The report must be clear and explanatory enough to aid the referring laryngologist with differential diagnosis and treatment planning. Moreover, the report must be capable of predicting treatment outcomes and powerful enough to warn the treating physician of any possible complications to the voice that may result from the proposed or planned treatment(s)—whether medical, surgical, therapeutic, or a combination. Clinical voice evaluation is not a quick procedure. It may take up to 1 hour to conduct phonatory function studies (PhFS) on a noncomplicated patient, whereas it may take 2 hours or even longer to evaluate and to process voice results of a professional voice user.

The contemporary initial clinical voice exam comprises a battery of PhFS including at least the following parts: (1) a detailed voice history (Hx) (CPT 99201) and usage needs (CPT 92506); (2) an acoustic portion that examines the nature of the generated sound (CPT 92520, 92521, 92522); (3) physiologic components comprising: (3A) a visual portion that examines the glottis and surrounding area including the subglottis via transoral or transnasal optical imaging (CPT 31579), (3B) other physiologic measures described later in this chapter; and (4) when applicable, a trial of exploratory/diagnostic voice treatment (Tx) (CPT 92507). Visualization is supported with various currently available technologies (detailed later in this chapter), of which the most commonly used is stroboscopic illumination. Visualization of the subglottis is of paramount clinical value when examining patients with voice problems due to papilloma, trauma, amyloidosis, and/or subglottic stenosis. The exam must result in a clinically relevant description of the parameters that specify and regulate the vibratory patterns (kinematics) of the vocal cords and/or the other vocal tract elements that are causative of dysphonia. (Note: When examining alaryngeal patients, or when utilizing other procedures or tests, additional CPT codes apply. Typically, a speech/voice pathologist (SLP) practicing in an ENT setting is encouraged to apply Medicare CPT Coding Rules or contractual insurance carrier charges, all in accordance with ASHA regulations.)

PHONATORY FUNCTION STUDIES

PhFS are considered a standard in modern voice care because they provide information beyond subjective clinical impressions; they also provide objective descriptions of normal and pathologic phonatory processes. These processes include (1) mapping acoustic voice characteristics, (2) correlating voice with physiologic findings, (3) providing guidelines for the development of efficacious treatment plans, (4) predicting the progress and outcomes of treatment plans, (5) providing preoperative–postoperative lesion mappings, and (6) providing documentation for medico-legal purposes. PhFS are reproducible and objective; these studies enable providers to contrast individual results to a specific database to reflect a patient’s age and gender. The information these studies provide also allows for a frank discussion with ...

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