The Association Between Cervical Spine Alignment and Voice Symptoms in Patients With Voice Disorders: A Prospective...

Although neck posture can influence voice and phonation by affecting laryngeal positioning, muscle tension, and respiratory dynamics, there is a lack of studies evaluating cervical spine status in patients with voice disorders. This study aimed to assess the association between cervical spine alignment, measured using radiographic parameters, and voice assessment in patients with voice disorders.

Patients with voice disorders who visited an otolaryngology clinic were prospectively enrolled. Patients were divided into hyperfunctional and nonhyperfunctional voice disorder groups. Voice quality was evaluated using the Voice Handicap Index-10 (VHI-10), and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) scale, acoustic analysis, and aerodynamic study. Cervical spine alignment was evaluated via lateral cervical radiography, measuring C2-7 lordosis, C2-7 sagittal vertical axis (SVA), and chin-brow vertical angle. Correlations between the cervical spine alignment parameters and voice assessments within each group were analyzed using Spearman's rank correlation.

Seventy patients with voice disorders were enrolled in this study, 35 patients with hyperfunctional voice disorders and 35 patients with nonhyperfunctional voice disorders. The hyperfunctional group showed significantly less C2-7 lordosis than the nonhyperfunctional group (P = 0.011), indicating a more forward-flexed neck posture. In the hyperfunctional group, C2-7 lordosis showed significant positive correlation with the total VHI-10 score (P = 0.047), and with physical (P17), functional (F22), and emotional (E23) VHI items. Breathiness and Strain components of the GRBAS scale also showed significant correlation with C2-7 lordosis (P = 0.040 and 0.026, respectively). No meaningful correlations were found in the nonhyperfunctional group.

C2-7 lordosis, a measure of cervical alignment, was significantly associated with voice symptoms in patients with hyperfunctional voice disorders. These findings suggest that cervical posture may influence voice quality and should be considered in the assessment and management of voice disorders, particularly in patients with hyperfunctional patterns.