Age/Gender Differences
There were some demographic differences between the laryngeal group and the pre-neck surgery group. In the pre-neck surgery group the female:male ratio was 80:20 and in the group with laryngeal disease the ratio was 60:40. (While populations of patients with voice complaints have a high female:male ratio, thyroid disease has an even higher female:male ratio.) There also was a difference in age. The voice complaint group's average age was 43 and the pre-neck surgery groups' average age was 50 (p< .0001).
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In the pre neck surgery group, about 65% of patients had no laryngeal disorder in both males and females. In females 14% had a mucosal lesion, 8 % had postmenopausal vocal limitations, 6% had deconditioning findings and 6% had other laryngeal disorders. In men 10% had mucosal lesions, 17% had deconditioning findings and 9% other laryngeal disorders.
Talkativeness/Loudness relationship to laryngeal findings
To determine whether laryngeal subcategory was related to talkativenss, all patients were analyzed by the subcategories in the following table.
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Category
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N
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Which diagnoses were included in the category
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Acute mucosal
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3 |
People who identified a single event such as a yell at which time their voice abruptly changed and on exam they had a mucosal injury. They had no prior history of any voice problems.
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Chronic mucosal
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250
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Long standing voice problems and diagnoses including vocal fold nodules, vocal fold polyps, capillary ectasia, hemorrhage, cyst, sulci and smokers polyps (Reinke's edema).
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Deconditioning
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79
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Bowing/presbyphonia and voice fatigue syndrome.
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Post menopausal
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38
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Post menopausal voice changes
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Inflammatory
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37
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Granulomas, infectious laryngitis, laryngitis sicca and rheumatoid nodules.
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Neurologic
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88
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Vocal fold paralysis, paresis, atrophy, spasmodic dysphonia, tremor and CNS disorders such as parkinsonism.
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Nonorganic
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29
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Psychogenic voice changes.
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Normal
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355
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Patients seen for pre-neck surgery exam with no voice complaints and no abnormal laryngeal findings.
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Sensations
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15
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Cricopharyngeal spasm, hyoidynia, carotidynia and muscle based pain.
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Technique
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9
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Muscle tension dysphonia.
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Trauma
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23
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External laryngeal injuries, intubation and non-neurologic surgical injuries.
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Tumor
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48
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This group included neoplasia and other growths on the larynx: leukoplakia, benign laryngeal tumors, squamous cell carcinoma, papillomatosis and saccular cysts.
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No significant differences in the degree of talkativeness were found between laryngeal subcategory and talkativenss, except between chronic mucosal disease (p=.0001), deconditioning disorders (p=.001), and normal patients (p=.0001). Thus, the remaining disorders; acute mucosal, inflammatory, neurologic, nonorganic, technique, trauma, tumor, dysphagia and sensations were grouped together as "other" laryngeal disease.
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Talkativeness
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The mucosal disorder group (overdoers) had a mean talkativeness of 6.2 (s.d.1.3), normals 4.8 (s.d. 1.3), deconditioning disorders (underdoers) 4.1 (s.d. 1.3) and other laryngeal disease 4.9 (s.d 1.4). See figure on right.
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81% of patients who were subsequently found to have mucosal disorders rated their talkativeness as a 6 or greater. This can be compared with only 30% of the normals and 44% of other laryngeal disease groups rating themselves as a 6 or greater. See table 3. In the voice complaint group, 89% of those found to have mucosal disease rated themselves a 6 or higher. 64% of the pre neck surgery group with mucosal disease rated themselves a 6 or higher. Another view in the voice complaint group is that 55% of patients rating themselves 5.5 or higher have mucosal disease, while 70% of patients rating themselves a 7 had mucosal disease.
25% of the deconditioning group rated themselves a 3 or less compared to 9% of normals, 10% of other laryngeal disease and 2% of patients with mucosal disease.
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Loudness
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Analyzing the four groups on the loudness scale, the mucosal disorder group (overdoers) had a mean loudness of 5.0 (s.d. 1.1), normals 4.2 (s.d. 1.1) other laryngeal diseases 4.0 (s.d. 1.1) and deconditioned (underdoers) 3.6 (s.d. 1.0). The deconditioned group were significantly softer than both the mucosal and normal groups (p=.001). While the mucosal group were significantly louder than all three groups (p=.001) See figure on right.
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Talkativeness Loudness relationship
Using a simple regression, talkativeness was dependant on loudness with a correlation coefficient of .57 (p=.0001). Loudness was dependant on talkativeness with a correlation coefficient of .34 (p=.0001). They are certainly not independent variables. Using a stepwise regression talkativeness (coefficient of correlation .137) seems to play a greater role in predicting disease than loudness (coefficient of correlation .095).
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