Clinical Question: What are the prevalence and causes of dysphonia as diagnosed by primary care physicians and otolaryngologists in a large population?
Background: Although the need for prevalence studies of voice disorders has been recognized, some limitations exist within the literature. Epidemiologic data are necessary, because prevalence rates or voice complaints depend on the population studies (regional vs. national) and the definition of a voice disorder. Additionally, epidemiologic studies are important for understanding impact, evaluation and management.
Study design: Retrospective analysis of data from a large, nationally representative administrative U.S. claims database.
Setting: Duke Voice Care Center, Division of Otolaryngology-Head and Neck Surgery, Duke University Medical Center, Durham, N.C.; Division of Public Health, Study Design and Biostatistics Center, Department of Communication Sciences and Disorders, Division of Otolaryngology-Head and Neck Surgery and Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City; and Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco.
Synopsis: From almost 55 million individuals in the database, 536,943 (prevalence rate of 0.98 percent) were given a dysphonia diagnosis. The prevalence was higher among women compared with men (1.2 percent vs. 0.7 percent) and among those older than 70 years. The most frequent diagnoses were acute laryngitis, nonspecific dysphonia, benign vocal fold lesions and chronic laryngitis. Primary care physicians more commonly diagnosed acute laryngitis, whereas otolaryngologists more commonly diagnosed nonspecific dysphonia and laryngeal pathology. Gastroesophageal reflux was more commonly diagnosed as a comorbid condition by otolaryngologists than by primary care doctors. Overall, laryngeal cancer prevalence was 2.2 percent and was greatest among males older than 70 years. Only 22.4 percent of the elderly had seen a physician for voice problems. The authors noted that data from an administrative claims database have intrinsic potential sources of bias that might affect outcomes.
Bottom line: The voice disorders prevalence rate was approximately 1 percent, with females representing the majority of patients and cases highest among those 70 and older. Diagnoses differed depending on physician specialty.
Reference: Cohen SM, Kim J, Roy N, et al. Prevalence and causes of dysphonia in a large treatment-seeking population. Laryngoscope. 2012;122(2):343-348.