Spectrum of dysphonia: Diagnosis, demographics, and quality of life

Objectives: To characterize and compare voice-related quality-of-life (VRQOL), demographics, and symptomatology in patients with dysphonia presenting to an academic laryngology practice. Study design: Prospective cohort study. Methods: All new patients presenting with chief complaint of dysphonia from May 2007 - April 2009 were included. Baseline characteristics and impact of diagnosis on VRQOL were analyzed with one-way ANOVA. Multivariate regression identified those factors most predictive of overall VRQOL. Results: 551 patients (11-96 years; 38.2% male/61.8% female) were categorized: 29.0% inflammatory; 19.0% paralysis; 16.5% phonotrauma; 11.5% functional; 9.8% post-traumatic; 7.1% other neurologic; 4.6% neoplasm; and 2.5% stenosis/other. Among these groups, neoplastic had the greatest proportion of males (p=0.0009) and highest current smokers and total packyears (p<0.0001 for each). Odynophonia, odynophagia, and otalgia were highest with functional dysphonia (p=0.0001, 0.0324, 0.0001), while dysphagia was highest with paralysis and stenosis/other (p=0.0002). Neurologic disease had longest duration of dysphonia (mean 72 months); the next longest group was neoplasm (42 months, p=0.0003). Overall VRQOL was 70-74 for phonotraumatic, post-traumatic, neoplastic, and inflammatory conditions and 45-56 for paralysis, functional, neurologic, and stenosis/other (p<0.0001). In multivariate regression, age, gender, and smoking were not predictive of individual VRQOL while paralysis and stenosis/other correlated with low VRQOL (p=0.018 and 0.043). Conclusion: There are significant differences among causes of dysphonia with regard to baseline demographics, associated clinical characteristics, and VRQOL. Comparative knowledge of these conditions and an understanding of their relative proportions may speed diagnosis and improve treatment of patients with voice complaints.