File
Langenfeld A.1,2,3, Bohlender J.E.1, Swanenburg J.3,4, Brockmann-Bauser M.1
1University Hospital Zurich, Department of Phoniatrics and Speech Pathology, Clinic for Otorhinolaryngology, Head and Neck Surgery, Zurich, Switzerland, 2Maastricht University, CAPHRI, Maastricht, Netherlands, 3University of Zurich and University Hospital Balgrist, Department of Chiropractic Medicine, Zurich, Switzerland, 4University Hospital Zurich, Physiotherapy Occupational Therapy Research Centre, Directorate of Research and Education, Zurich, Switzerland
Background: Neck pain is known as one of the risk factors for the development of voice disorders. In turn pain in the back of the cervical region and the shoulder girdle may be caused by inappropriate vocal behavior, finally leading to an increased muscle tension and muscle tension dysphonia.
Purpose: The goal was to investigate if there is a correlation between neck related subjective symptoms and voice disorder related subjective symptoms in patients diagnosed with voice disorders.
Methods: In a cross-sectional study patients were selected from the clinical database of the department of Phoniatrics and Speech Pathology, University Hospital Zurich, Zurich, Switzerland. Eligibility criteria were > 18 years of age and a primary complaint related to a diagnosed organic voice disorder (benign lesions) or muscle tension dysphonia. Excluded were patients with any systemic diseases, a recent history of cancer, intubation within the last 18 month and a limited ability to fill out the questionnaires. Outcome measures were the Voice Handicap Index (VHI) to assess voice related symptoms, and the Neck Disability Index (NDI) assessing pain and disability related to neck muscles. Spearman rank-order coefficient was used to assess the correlation between the VHI and NDI (rs). Additionally the population was dichotomized into following subgroups: functional vs. organic disorder, age±60 years, gender and single item correlations of the questionnaires for the total sample as for each sub-group.
Results: 100 patients, 59 female (mean=50.01 years SD16, range 24-87) of which 68 were 60, were included. 50 patients were diagnosed with muscle tension dysphonia and 50 with organic voice disorder. Mean overall VHI score was 13.93 (SD=7.81, range=0-31) and mean NDI score was 6.07 (SD 7.71, range 0-43). There was a significant mild correlation between both questionnaires` total scores (r = .220, p =.02). The correlation was stronger in patients with organic (r = .297, p = .03) as compared to functional (r = .148, p = .30) voice disorders. The different age groups showed no statistically significant correlation 60 years (r = .149, p = .22), > 60 years (r = .287, p = .11). Male patients had a stronger agreement between both questionnaires (r = 317, p = .04) versus female (p = .192, p = .14). Single item correlation was highest between VHI item P4 (physiological) and NDI item Reading (cognitive functioning) (r= .480, p= .002).
Conclusion(s): We used the gold standard to assess neck pain, in patients with either muscle tension dysphonia or organic voice disorders. In our sample there was a significant mild correlation between voice and neck related symptoms of both questionnaires. Male patients mainly had correlations between items focusing on pain and neck disability of the neck and with physiological items related to voice symptoms disorders. Patients with organic voice disorders show mainly correlations between cognitive functioning and emotional factors.
Implications: Patients with voice disorders may show clinical symptoms of neck related complaints. It is important to evaluate and treat the underlying causes, since these may contribute to the voice disorder.
Funding acknowledgements: None
Topic: Musculoskeletal: spine
Ethics approval: Ethics Commission of the Canton of Zurich
All authors, affiliations and abstracts have been published as submitted.
