Mucosal disease and other laryngeal disease peaked in the 40 years old age group. Deconditioning and postmenopausal endocrine disorders peaked in the 70 year old age group. While patients with voice complaints have a high female:male ratio, thyroid disease has an even higher female:male ratio. The control group is thus not an entirely normal population but the 14% incidence of mucosal disease in women and 10% in men might represent a first approximation of the incidence in a larger population. If this ratio of 1.4:1 incidence is correct, then the incidence of 2.6:1 in a laryngeal clinic might suggest that women are more sensitive to the effects of a mucosal disorder. Additionally the people with mucosal disease in the control group typically did not have voice complaints. Mucosal disease is a benign disorder that only requires treatment for symptoms.

Talkativeness/Loudness and laryngeal disorders

The results from this study demonstrate that level of patient talkativeness and vocal loudness can be placed on a continuum. A high degree of talkativeness and loudness correlate with laryngeal mucosal disorders such as nodules, polyps, capillary ectasias and hemorrhage. A person with a strong inner drive to talk tends to be socially gregarious. They often gravitate toward careers that capitalize on their innate sociality. Singing, acting and sales are examples of occupations that utilize the voice extensively and people with this strong inner drive to speak will often be most happy in careers of this type. Because this drive is innate, the tendency to talk will be just as evident during off work hours as well. They will be comfortable in the company of other talkers. When this innate "pull from within" is coupled with an extrinsic need to speak such as at the workplace "pull from without", these patients may be termed "vocal overdoers".

In this study, personality as defined by high levels of talkativeness and loudness is correlated with the type of laryngeal disorder the patient suffers from. Determining where a patient belongs on the vocal overdoer/underdoer continuum is valuable and highly orienting information for the clinician since it focuses the diagnostic process, including the physical examination of the larynx. Additionally it directs treatment at the etiology of the disorder. Since more than 80% of patients subsequently found to have mucosal disease will rate their talkativeness as a 6 or 7, this rating provides a strong clue to the clinician to look for mucosal disease symptoms on the remainder of the history. The laryngeal exam can be very focused on the mucosal surface if the lesion is not initially obvious.

An underdoer lacks the inner drive to speak. They are comfortable with long periods of silence. They will tend to gravitate toward careers that do not require social interaction. Computer programming, accounting, library work, laboratory research are examples of careers that may not require much speaking at all. These people may be quite happy in the quiet of their home after work. A patient defined as a vocal underdoer by the combination of lower than average talkativeness, lower than average loudness (a 4 or less on the scales) and little "pull from without" to talk will more likely have a deconditioning or muscle atrophy type disorder. Time of life may also affect the "pull from without" and an elderly person living alone may have long periods of vocal inactivity and have little need to speak. A patient with lower than average talkativeness and loudness combined with a strong "pull from without" will more likely suffer from voice fatigue syndrome. Also, while vocal bowing can be treated surgically, when the etiology of the disorder rests in part or whole on the patient status as an underdoer, behavioral management such as voice building is always given first chance.

Though the average rating by patients eventually found to have a deconditioning type of disorder is 4.1 and other laryngeal disorders and normal patients more often rate themselves near a 5, there is less discrimination between these groups than between overdoers with mucosal disease and other laryngeal disorders.

It is interesting to note that few people rate themselves a 1 or a 2 on these seven point scales. Perhaps these scales do not have a bell shaped distribution or perhaps people with little drive or need to talk would not recognize or seek treatment for a voice disorder if they had one. 8% of patients undergoing neck surgery had evidence of a deconditioning disorder. Of these 30% rated themselves a 3 or less. Perhaps patients with deconditioning disorders seek medical care less often than a talkative person with a mucosal disorder would.

After the diagnosis, these overdoer and underdoer characteristics can be useful information for the patient, the laryngologist and the speech therapist. Mucosal disease can, and often should be treated surgically, but if the patient with mucosal disease is, as usual a vocal overdoer, then behavioral management always comes first. Behavioral modification should be directed at lifestyle management for the vocal overdoer. This priority of treatment allows the patient the opportunity to heal the lesion and/or prepare them for surgery with a reduced chance of recurrence after the surgery. For example, a laryngologist may surgically remove a polyp for a patient that answers a "7" and a "7" on talkativeness and loudness scales. Since these 7's represent behaviors, they will need behavioral management or the patient's talkativeness is likely to cause a disease recurrence. This is equally true for the underdoers who rates themselves as a "3" and a "3". Vocal exercises to get their voice usage up on a daily basis may increase intrinsic laryngeal muscle bulk or tone and correct their bowing or presbyphonia problem to the patients satisfaction.

The lack of correlation of these personality traits, talkativeness and loudness with other types of laryngeal disease (Tumor, trauma, etc.) suggests that while talkativeness and loudness do play a role in the development of mucosal and deconditioning disorders, they play less of a role in other laryngeal diseases. The statistical similarity of talkativeness and loudness between the "other" laryngeal disease group and a normal population group (pre-neck surgery) also suggests that this part of personality (talkativeness and loudness) does not play a major role in the development of these other types of laryngeal disease.