Self-Reported Impact of Dysphonia in a Primary Care Population: An Epidemiological Study

Objectives/Hypothesis: This study's objectives are to 1) to assess the prevalence of dysphonia in the primary care community, 2) evaluate the severity of dysphonia, 3) explore potential risk factors for dysphonia, 4) examine the treatment of dysphonic patients, and 5) assess treatment-related barriers. The hypotheses are that 1) dysphonia is common in the primary care community, 2) it adversely impacts patients' quality of life (QOL), and 3) patients are underevaluated and experience obstacles with respect to seeking treatment. Study Design: Cross-sectional, practice-based study in the primary care population. Methods: English-speaking patients 18 years of age and older were recruited from a primary care research network. Patients presenting to their primary care practices were given a packet of questionnaires to complete that documented demographic information, risk factors, presence of dysphonia, prior treatment, and reasons for not seeking treatment. The Voice-Related Quality of Life (VRQOL) and Center for Epidemiological Studies-Depression Scale (CES-D) served as quality-of-life outcome measures. A priori sample size calculations were performed indicating a sample size of 780. Univariate analyses, descriptive statistics, odds ratios and 95% confidence intervals, and multivariate analyses were performed. Results: A total of 789 patients with a mean age of 49.9 years and range of 18 to 94 years participated. Lifetime prevalence of dysphonia was 29.1%, point prevalence of dysphonia 7.5%, and 4.3% had had dysphonia for >4 weeks. Of those with current dysphonia, only 46% had not missed work. Of those with current dysphonia, 73.3% had had dysphonia more than once. Patients with dysphonia had lower VRQOL scores and higher CES-D scores (t test, P <.001). Risk factors for dysphonia and impaired VRQOL on multivariate analysis included neurologic disease, dry mouth, family history of dysphonia, college or postgraduate level education, allergies or sinus problems, neck pain, medication for depression/anxiety, more than three upper respiratory infections per year, gastroesophageal reflux at least monthly, and asthma or lung disease. Of the patients who had ever had dysphonia, 22.1% received treatment. Common treatment modalities included antireflux treatment, antiallergy treatment, and antibiotics. Speech-language pathology evaluation was rare. Compared to those not interested in treatment, patients wanting treatment were more likely to have chronic dysphonia >4 weeks (30.6% vs. 8.1%; v 2, P <=.001), more likely to have dysphonia more than once (85.1% vs. 58.0%; v 2, P <=.001), and lower VRQOL scores (median 67.5 vs. 97.5; rank sum test, P <.001). Reasons for not seeking treatment included thinking the dysphonia would go away, physicians did not ask about voice problems, and being unaware of treatment options. Conclusions: At the time one in 13 primary care patients had dysphonia resulting in significant functional impairment with reduced voice-specific QOL and greater depression scores. Risk factors for dysphonia and voice-specific QOL impairment were identified and might be useful for identifying patients at risk for dysphonia. Barriers exist that prevent dysphonic patients from receiving evaluation and treatment. Whether improved methods of dysphonia screening leads to better outcomes and reduced societal impact needs investigation.