Prevalence and causes of dysphonia in a large treatment-seeking population

Objective: To determine the prevalence and common causes of dysphonia as diagnosed by primary care physicians (PCPs) and otolaryngologists, and to evaluate differences in etiologies offered by these providers. Study Design: Retrospective analysis of data from a large, nationally representative administrative U.S. claims database. Methods: Patients were identified as dysphonic based on ICD-9-CM codes from January 1, 2004 to December 31, 2008. Data regarding age, gender, geographic location, and type of physician providing the dysphonia diagnosis were collected. Overall and age-related prevalence rates, as well as frequency of specific etiologies by provider type were calculated. Results: Of the almost 55 million individuals in the database, 536,943 patients, ages 0 to > 65 years, were given a dysphonia diagnosis (point prevalence rate of 0.98%). The prevalence rate was higher among females as compared to males (1.2% versus 0.7%) and among those > 70 years of age (2.5%). The most frequent diagnoses overall were acute laryngitis, non-specific dysphonia, benign vocal fold lesions, and chronic laryngitis. PCPs more commonly diagnosed acute laryngitis, whereas otolaryngologists more commonly diagnosed non-specific dysphonia and laryngeal pathology. Gastro-esophageal reflux was more commonly diagnosed as a comorbid condition by otolaryngologists than by PCPs. Overall laryngeal cancer prevalence in this treatment-seeking population was 2.2% and was greatest among males > 70 years of age. Conclusion: This analysis of insurance claims data from a nationally representative database represents the largest study of its kind. Important differences in dysphonia prevalence related to age, gender, diagnosis, and physician type were identified. Word count: 248, Evidence level: level 2b. Introduction: The public health impact of vocal dysfunction is becoming increasingly recognized. Dysphonia adversely impacts communication with physical, social, and workrelated effects. Patients suffer social isolation, depression, impaired disease-specific and general quality of life, and work absenteeism.1-4 Thus, voice disorders negatively impact individuals and burden society.