Demographic characteristics and spectrum of comorbidities in patients with muscle tension dysphonia: a retrospective cross-sectional study

Jelena Sotirović; Maša Petrović; Milanko Milojević; Nenad Baletić; Ognjen Čukić; Ivan Zaletel

doi:10.2298/VSP241029031S

Jelena Sotirović Military Medical Academy, Clinic for Otorhinolaryngology, Belgrade, Serbia; †University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Maša Petrović University of Belgrade, Faculty of Medicine, Belgrade, Serbia; Institute for Cardiovascular Diseases “Dedinje”, Belgrade, Serbia
Milanko Milojević Military Medical Academy, Clinic for Otorhinolaryngology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Nenad Baletić Military Medical Academy, Clinic for Otorhinolaryngology, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Ognjen Čukić Military Medical Academy, Clinic for Otorhinolaryngology, Belgrade, Serbia
Ivan Zaletel Institute for Histology and Embryology “Aleksandar Đ. Kostić”, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP241029031S

Keywords: comorbidity;, demography;, dysphonia;, prevalence;, serbia

Abstract

Background/Aim. Muscle tension dysphonia (MTD) is one of the most common voice disorders. The aim of the study was to examine demographic characteristics and the prevalence of comorbidities in patients diagnosed with MTD. Methods. A retrospective cross-sectional study included an analysis of demographic characteristics and comorbidities in 87 patients diagnosed with MTD during a one-year period. Results. The mean age of the patients was 49.2 years (range 18–84 years), and 79.3% were younger than 65 years. The female gender comprised 73.6%. No statistically significant difference was found in smoking status between men and women (χ² = 0.624; p ˃ 0.05). Out of the 87 patients, 43 (49.4%) were professional voice users. Among these patients, 20 (46.5%) were school teachers, 8 (18.6%) sales-related occupations, 5 (11.6%) professional singers, 3 (7.0%) kindergarten teachers, 3 (7.0%) lecturers, 2 (4.6%) psychologists, 1 (2.3%) speech-language pathologist, and 1 (2.3%) fitness instructor. Secondary MTD was diagnosed in 36 (41.4%) patients. The most common clinical findings diagnosed in those with secondary MTD were vocal cord nodules in 24 patients (66.7%). The prevalence of comorbidities were as follows: mild to moderate hearing loss (9.2%), postnasal drip (31.0%), hypersensitivity to common inhalant allergens (31.0%), asthma or chronic obstructive pulmonary disease (18.4%), thyroid dysfunction (17.2%), and history of gastroesophageal reflux disease (21.8%). Conclusion. MTD is more frequent in females and professional voice users. Due to the high prevalence of comorbidities in MTD patients, a detailed history and additional examinations are necessary in order to determine the final treatment plan.

References

Van Houtte E, Claeys S, D'haeseleer E, Wuyts F, Van Lierde K. An examination of surface EMG for the assessment of muscle tension dysphonia. J Voice 2013; 27(2): 177–86.

Khoddami SM, Nakhostin Ansari N, Izadi F, Talebian Moghadam S. The assessment methods of laryngeal muscle activity in muscle tension dysphonia: a review. ScientificWorldJournal 2013; 2013: 507397.

Van Houtte E, Van Lierde K, Claeys S. Pathophysiology and treatment of muscle tension dysphonia: a review of the cur-rent knowledge. J Voice 2011; 25(2): 202–7.

Garaycochea O, Navarrete JMA, Del Río B, Fernández S. Muscle Tension Dysphonia: Which Laryngoscopic Features Can We Rely on for Diagnosis? J Voice 2019; 33(5): 812.e15–8.

Jafari N, Salehi A, Meerschman I, Izadi F, Ebadi A, Talebian S, et al. A Novel Laryngeal Palpatory Scale (LPS) in Patients with Muscle Tension Dysphonia. J Voice 2020; 34(3): 488.e9–27.

Da Cunha Pereira G, de Oliveira Lemos I, Dalbosco Gadenz C, Cassol M. Effects of Voice Therapy on Muscle Tension Dys-phonia: A Systematic Literature Review. J Voice 2018; 32(5): 546–52.

Koufman JA, Isaacson G. The spectrum of vocal dysfunction. Otolaryngol Clin North Am 1991; 24(5): 985–8.

Jacks A, Kavookjian H, Kraft S. Comparative Evaluation and Management of Dysphonia Between Adults <65 and ≥65 Years of Age. Otolaryngol Head Neck Surg 2021; 165(1): 142–8.

Altman KW, Atkinson C, Lazarus C. Current and emerging concepts in muscle tension dysphonia: a 30-month review. J Voice 2005; 19(2): 261–7.

Sataloff RT. Professional voice users: the evaluation of voice disorders. Occup Med 2001; 16(4): 633–47.

Ebersole B, Soni RS, Moran K, Lango M, Devarajan K, Jamal N. The Influence of Occupation on Self-perceived Vocal Prob-lems in Patients With Voice Complaints. J Voice 2018; 32(6): 673–80.

Kost K, Parham K. Presbyphonia: What can be done? Ear Nose Throat J 2017; 96(3): 108–10.

Belafsky PC, Postma GN, Reulbach TR, Holland BW, Koufman JA. Muscle tension dysphonia as a sign of underlying glottal insufficiency. Otolaryngol Head Neck Surg 2002; 127(5): 448–51.

Rapoport SK, Menier J, Grant N. Voice Changes in the Elderly. Otolaryngol Clin North Am 2018; 51(4): 759–68.

Mozzanica F, Ginocchio D, Barillari R, Barozzi S, Maruzzi P, Ot-taviani F, et al. Prevalence and Voice Characteristics of Laryn-geal Pathology in an Italian Voice Therapy-seeking Popula-tion. J Voice 2016; 30(6): 774.e13–21.

Misono S, Peterson CB, Meredith L, Banks K, Bandyopadhyay D, Yueh B, et al. Psychosocial distress in patients presenting with voice concerns. J Voice 2014; 28(6): 753–61.

Dietrich M, Verdolini Abbott K, Gartner-Schmidt J, Rosen CA. The frequency of perceived stress, anxiety, and depression in patients with common pathologies affecting voice. J Voice 2008; 22(4): 472–88.

Mora R, Crippa B, Cervoni E, Santomauro V, Guastini L. Acous-tic features of voice in patients with severe hearing loss. J Otolaryngol Head Neck Surg 2012; 41(1): 8–13.

Ross J, Valentino WL, Calder A, Bigly D, Othman S, McKinnon B, et al. Utility of Audiometry in the Evaluation of Patients Pre-senting with Dysphonia. Ann Otol Rhinol Laryngol 2020; 129(4): 333–9.

Hengen J, Hammarström IL, Stenfelt S. Perceived Voice Quality and Voice-Related Problems Among Older Adults with Hear-ing Impairments. J Speech Lang Hear Res 2018; 61(9): 2168–78.

Statistical Office of the Republic of Serbia; Milić N, Stanisavljević D, Krstić M, Jovanović V, Brcanski J, Kilibarda B, et al. The 2019 Serbian National Health Survey [Internet]. Belgrade: OMNIA BGD; 2021 [cited 2025 Jan 29]. Available from: https://publikacije.stat.gov.rs/G2021/pdfE/G20216003.pdf

Simberg S, Sala E, Tuomainen J, Rönnemaa AM. Vocal symptoms and allergy--a pilot study. J Voice 2009; 23(1): 136–9.

Bhalla RK, Watson G, Taylor W, Jones AS, Roland NJ. Acoustic analysis in asthmatics and the influence of inhaled corticoster-oid therapy. J Voice 2009; 23(4): 505–11.

Krouse JH, Altman KW. Rhinogenic laryngitis, cough, and the unified airway. Otolaryngol Clin North Am 2010; 43(1): 111–21, ix–x.

Spantideas N, Bougea A, Drosou E, Assimakopoulos D. The Role of Allergy in Phonation. J Voice 2019; 33(5): 811.e19–27.

Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, et al. International Consensus Statement on Allergy and Rhinol-ogy: Allergic Rhinitis. Int Forum Allergy Rhinol 2018; 8(2): 108–352.

Ohlsson AC, Drevsäter A, Brynnel M, Johansson I. Allergic rhini-tis and voice change. Logoped Phoniatr Vocol 2016; 41(4): 143–8.

Chaker L, Bianco AC, Jonklaas J, Peeters RP. Hypothyroidism. Lancet 2017; 390(10101): 1550–62.

Barić A, Brčić L, Gračan S, Škrabić V, Brekalo M, Šimunac M, et al. Thyroglobulin Antibodies are Associated with Symptom Burden in Patients with Hashimoto's Thyroiditis: A Cross-Sectional Study. Immunol Invest 2019; 48(2): 198–209.

Ott J, Promberger R, Kober F, Neuhold N, Tea M, Huber JC, et al. Hashimoto's thyroiditis affects symptom load and quality of life unrelated to hypothyroidism: a prospective case-control study in women undergoing thyroidectomy for benign goiter. Thyroid 2011; 21(2): 161–7. Erratum in: Thyroid 2011; 21(4): 467.

Guldvog I, Reitsma LC, Johnsen L, Lauzike A, Gibbs C, Carlsen E, et al. Thyroidectomy Versus Medical Management for Eu-thyroid Patients with Hashimoto Disease and Persisting Symp-toms: A Randomized Trial. Ann Intern Med 2019; 170(7): 453–64.

Saravanan P, Chau WF, Roberts N, Vedhara K, Greenwood R, Da-yan CM. Psychological well-being in patients on 'adequate' doses of l-thyroxine: results of a large, controlled community-based questionnaire study. Clin Endocrinol (Oxf) 2002; 57(5): 577–85.

Carta MG, Loviselli A, Hardoy MC, Massa S, Cadeddu M, Sardu C, et al. The link between thyroid autoimmunity (antithyroid peroxidase autoantibodies) with anxiety and mood disorders in the community: a field of interest for public health in the future. BMC Psychiatry 2004; 4: 25.

Hom C, Vaezi MF. Extraesophageal manifestations of gas-troesophageal reflux disease. Gastroenterol Clin North Am 2013; 42(1): 71–91.

Hanna BC, Wormald PJ. Gastroesophageal reflux and chronic rhinosinusitis. Curr Opin Otolaryngol Head Neck Surg 2012; 20(1): 15–8.