Due to concerns regarding the spread of COVID-19 through aerosolizing procedures, otolaryngologists and speech-language pathologists (SLPs) are deferring laryngeal visualization except when deemed vital and the benefits are judged to outweigh the risks. Examples of this include time sensitive, urgent, and emergent medical conditions as determined by the physician on a case-by-case basis. Under normal circumstances, best practice indicates visualization of the larynx, ideally via stroboscopy, is necessary prior to starting therapy. The American Speech-Language-Hearing Association (ASHA) Voice Disorders Practice Portal states, “all patients/clients with voice disorders are examined by a physician, preferably in a discipline appropriate to the presenting complaint. The physician's examination may occur before or after the voice evaluation by the speech-language pathologist.”
However, this presents a dilemma. If a person is negatively impacted by their voice disorder, and SLPs could provide treatment either in-person or via telepractice, can and should they do so without laryngeal visualization occurring first, or do they need to defer all voice therapy until after the larynx can be visualized?
Each situation should be evaluated individually, consistent with the ASHA Code of Ethics. Clinicians should follow state laws and regulations, and facilities and clinics should establish their protocols during the COVID-19 pandemic. The following are points for consideration during the COVID-19 pandemic:
The Special Interest Group 3 Coordinating Committee (Voice and Upper Airway Disorders) assisted with the development of this guidance.