Chiara Falanga1, Giuseppe Costa1, Umberto Volpe2, Dario Saracino3, Jerome R Lechien4, Carlos M Chiesa Estomba5, Marina Tripodi1, Giovanni Cammaroto6, Nicola Angelillo1, Andrea Nacci7, Maria Rosaria Barillari8. 1. Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, L. Vanvitelli University, Naples, Italy. 2. Clinical Psychiatry Unit, Department of Clinical Neurosciences, Università Politecnica delle Marche, Ancona, Italy. 3. Sorbonne Université, Paris Brain Institute - Institut du Cerveau - ICM, AP-HP - Hôpital Pitié-Salpêtrière, Paris, France. 4. Department of Otolaryngology-Head and Neck Surgery, School of Medicine, UFR Simone Veil, Foch Hospital, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France; Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium; Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France. 5. Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otorhinolaryngology, Osakidetza, Donostia University Hospital, San Sebastian, Spain. 6. Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France; Department of Otolaryngology-Head & Neck Surgery, Morgagni Pierantoni Hospital, Forli, Italy. 7. ENT Audiology and Phoniatric Unit, University of Pisa, Pisa, Italy. 8. Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, L. Vanvitelli University, Naples, Italy; Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France. Electronic address: mariarosaria.barillari@unicampania.it.
Abstract
OBJECTIVES: To evaluate the correlation between voice disorders and psychological distress, in terms of anxiety, stress, and depression, in a sample of adult Italian patients and to compare our results with those obtained in a group of adult healthy controls matched by age, sex, geographic distribution, and occupation. METHODS: This prospective-controlled study included 100 adults with Vocal nodules (VN) and Muscle Tension Dysphonia (MTD1), aged between 18 and 65 years, as Experimental Group (EG) and 100 age-matched subjects without any voice disorders as a Control Group (CG). All patients in the EG underwent a phoniatric evaluation, including the administration of the Voice Handicap Index (VHI) and laryngeal examination. Both patients of EG and CG underwent a Psychological evaluation by means of standardized tests; Beck's Depression Inventory, State Anxiety Inventory (STAI 1-State Anxiety), Trait Anxiety Inventory (STAI 2- Trait Anxiety), and Perceived Stress Scale (PSS-10) were completed by patients. Fisher's exact test and chi-squared test were used to compare all categorical variables, whereas numerical variables were compared either with the nonparametric Mann-Whitney-Wilcoxon or with Kruskal Wallis test. General linear models were used to study continuous variables between patients and controls and between different groups within the sample. RESULTS: In the study group, the Physical domain (P score) of the VHI was more affected than the Emotional (E score) and Functional ones (F score) both in patients with MTD1 and VN; patients with VN presented a significant difference in P score, E score and VHI total score than patients with isolated MTD 1 (P < 0.005). Psychological assessment showed a significant difference (P < 0.005) between VN and MTD 1 regarding PSS-10 and STAI-1 scores. Low Beck's Depression Inventory scores were present in our sample without significant differences between patients with VN and those with MTD 1. Scores related to psychological distress in the EG were far superior to those obtained by the healthy CG, with markedly significant values especially for PSS-10 (P < 0.0001) and STAI 2 (P < 0.01). Finally, younger patients (18-35 years) with VN showed a highest risk of psychosocial distress. CONCLUSION: the present study identified a high prevalence of psychological distress among patients with vocal disorders without any prior specific psychiatric diagnosis, especially in terms of anxiety and perceived stress. For this reason both these symptoms should be taken into consideration in the diagnostic, therapeutic, and follow-up process of patients with MTD1 and VN.
OBJECTIVES: To evaluate the correlation between voice disorders and psychological distress, in terms of anxiety, stress, and depression, in a sample of adult Italian patients and to compare our results with those obtained in a group of adult healthy controls matched by age, sex, geographic distribution, and occupation. METHODS: This prospective-controlled study included 100 adults with Vocal nodules (VN) and Muscle Tension Dysphonia (MTD1), aged between 18 and 65 years, as Experimental Group (EG) and 100 age-matched subjects without any voice disorders as a Control Group (CG). All patients in the EG underwent a phoniatric evaluation, including the administration of the Voice Handicap Index (VHI) and laryngeal examination. Both patients of EG and CG underwent a Psychological evaluation by means of standardized tests; Beck's Depression Inventory, State Anxiety Inventory (STAI 1-State Anxiety), Trait Anxiety Inventory (STAI 2- Trait Anxiety), and Perceived Stress Scale (PSS-10) were completed by patients. Fisher's exact test and chi-squared test were used to compare all categorical variables, whereas numerical variables were compared either with the nonparametric Mann-Whitney-Wilcoxon or with Kruskal Wallis test. General linear models were used to study continuous variables between patients and controls and between different groups within the sample. RESULTS: In the study group, the Physical domain (P score) of the VHI was more affected than the Emotional (E score) and Functional ones (F score) both in patients with MTD1 and VN; patients with VN presented a significant difference in P score, E score and VHI total score than patients with isolated MTD 1 (P < 0.005). Psychological assessment showed a significant difference (P < 0.005) between VN and MTD 1 regarding PSS-10 and STAI-1 scores. Low Beck's Depression Inventory scores were present in our sample without significant differences between patients with VN and those with MTD 1. Scores related to psychological distress in the EG were far superior to those obtained by the healthy CG, with markedly significant values especially for PSS-10 (P < 0.0001) and STAI 2 (P < 0.01). Finally, younger patients (18-35 years) with VN showed a highest risk of psychosocial distress. CONCLUSION: the present study identified a high prevalence of psychological distress among patients with vocal disorders without any prior specific psychiatric diagnosis, especially in terms of anxiety and perceived stress. For this reason both these symptoms should be taken into consideration in the diagnostic, therapeutic, and follow-up process of patients with MTD1 and VN.
Authors: Jerome R Lechien; Thomas Radulesco; Justin Michel; Sven Saussez; Christian Calvo-Henriquez; Carlos M Chiesa-Estomba; Stéphane Hans; Maria R Barillari; Giovanni Cammaroto; Géraldine Descamps; Julien Hsieh; Luigi Vaira; Giacomo De Riu; Leigh Sowerby; Isabelle Gengler Journal: Head Neck Pathol Date: 2020-08-20