Voice Disorders: A Defining Problem

Reported voice disorder prevalences vary widely across studies due to population heterogeneity and differences in operational definitions of voice disorders employed by those studies. The objective of this study was to compare responses to five questions using previously published operational definitions of voice disorder to each other and to measures of voice impact, and elicit definitions of "voice disorder" and potential reasons for care-seeking from nonclinical persons.

A cross-sectional convenience sample of adult attendees of the Minnesota State Fair completed a survey including five different operational definitions of a voice disorder, items targeting measures of functional voice impact, and qualitative reflections. Responses to the five operational definitions were analyzed using percent agreement and kappa coefficients, with descriptive statistics used to correlate definitions with measures of functional voice impact. Free-text responses were coded systematically to identify common themes and subthemes.

In 795 participants, comparison between operational definitions showed prevalence of voice disorders ranging from 4%-7% currently, 7%-15% in the past 12 months, and 39%-62% lifetime. Across operational definitions, percent agreement ranged from 70%-95%, with kappa coefficients 0.37-0.77. Mean VHI-10 scores among respondents reporting a current voice problem on any operational definition were 12.2-14.5 (SD=6.0-7.7). A total of 577 participants indicated a positive response to one or more operational definitions. Of these, 48 individuals (8.3%) reported having sought care. Free-text responses regarding what constitutes a voice problem and what would prompt care-seeking highlighted pain/discomfort as a salient theme. This theme is rarely represented in established operational definitions and functional voice impact scales.

The prevalence of voice problems measured using existing operational definitions was generally concordant with other ways to assess voice impact, but the specific definition wording meaningfully impacted prevalence estimates, especially across long time horizons. Future studies are needed to further elucidate care-seeking motivations and the importance of including pain/discomfort in voice problem prevalence estimates.