Health disparities among adults with voice problems in the United States.

OBJECTIVE: To assess differences in access to care and healthcare utilization among adults who reported voice problems in 2012. STUDY DESIGN: Cross-sectional study. METHODS: The 2012 National Health Interview Survey was utilized to evaluate adults who had a "voice problem in the past 12 months." Multivariate analyses determined the influence of sociodemographic variables on the prevalence of voice problems in adults and access to care. RESULTS: Among 243 million adults in the United States, 17.9 ± 0.05 million adults (7.63% ± 0.21%) report experiencing voice problems. After controlling for age, education, income level, geographic region, and health insurance status, African Americans (odds ratio [OR]: 0.83, P < 0.05), Hispanics (OR: 0.61, P < 0.01), and other minorities (OR: 0.69, P < 0.01) had a lower OR for reporting voice problems in the last year relative to white adults. Among adults with voice problems, Hispanics were more likely to delay care because they could not reach a medical office by telephone (OR: 1.85, P < 0.01) and due to long wait times at the doctor's office (OR: 2.04, P < 0.01) compared to white adults. Adults with voice problems who were a racial minority, low income, or had public health insurance were more likely to postpone care because they lacked a mode of transportation. CONCLUSION: Targeted programs are necessary to address the health disparities and barriers to care among those who suffer from voice problems. LEVEL OF EVIDENCE: IV. Laryngoscope, 128:915-920, 2018.

The economic impact of vocal attrition in public school teachers in Miami-Dade County.

OBJECTIVES/HYPOTHESIS: Teachers are a known at-risk population for voice disorders. The prevalence and risk factors for voice disorders have been well studied in this population, but little is known about the associated economic cost. The purpose of this study is to assess the economic impact of voice dysfunction in teachers and understand the difference between the cost of absenteeism and presenteeism as a direct result of voice dysfunction. STUDY DESIGN: Cross-sectional analysis via self-administered online questionnaire. METHODS: A total of 14,256 public school teachers from Miami-Dade County, Florida, were asked to participate. Questions were formatted based on the previously validated Work Productivity and Activity Impairment: Specific Health Problem questionnaire adapted for hoarseness and voice disorders. Additional demographic questions were included in the questionnaire. RESULTS: A total of 961 questionnaire responses were received. The demographic characteristics of respondents closely matched known statistics for public school teachers in Miami-Dade County. Economic calculations were performed for each questionnaire respondent and summed for all respondents to avoid bias. Per week, absenteeism-related costs were $25,000, whereas presenteeism-related costs were approximately $300,000. These figures were used to extrapolate annual cost. Per year, absenteeism-related costs were $1 million, whereas presenteeism-related costs were approximately $12 million. CONCLUSION: The economic impact of voice dysfunction on the teaching profession is enormous. With the above calculations only including lost wages and decreased productivity, the actual figures may in fact be larger (cost of substitute teachers, impact on nonwork activities, etc.). Research investigating preventative measures for voice dysfunction in teachers is necessary to reduce this costly issue. LEVEL OF EVIDENCE: 2C. Laryngoscope, 126:665-671, 2016.

Medical Costs and Productivity Costs Related to Voice Symptoms in Colombian Teachers.

OBJECTIVES: To investigate the medical costs and productivity costs of voice symptoms among teachers and to assess the contribution of the characteristics of voice symptoms, sociodemographic characteristics, health conditions, and work-related factors to these costs. STUDY DESIGN: This is a cross-sectional study. METHODS: In 2012, we conducted a longitudinal study in 12 public schools in Bogotá D.C., Colombia. This study is focused on cross-sectional results obtained in the first stage of the data collection process. Participants filled out a questionnaire on sociodemographics, voice symptoms, work-related conditions, use of health care, productivity loss at work, and sickness absence. Multiple logistic regression analysis was used to explore associations among health care use, voice-related absenteeism and productivity loss with duration and severity of voice symptoms, sociodemographic characteristics, health conditions, and work-related factors. RESULTS: In total, 621 Colombian teachers participated in this research, 438 of whom had self-reported voice complaints and who therefore made up the study population. Total medical costs and productivity costs due to presence of voice symptoms among teachers with voice complaints equaled around 37% of their monthly wage. Approximately, 3% of the costs were direct costs for health care use, and 97% were indirect costs for productivity losses. Severity of voice symptoms was significantly associated with health care use and absenteeism. CONCLUSIONS: Voice symptoms among teachers have important economic consequences because of health care use, voice-related absenteeism, and productivity loss at work.

Voicing an impact: who does the National Institutes of Health support for voice disorder research?

PURPOSE: Interest in a variety of neoplastic, functional, neurological, and age-related laryngeal disorders has contributed to the development of laryngology as an established subspecialty. Funding support plays a critical role in facilitating scholarship within the field. Our objectives were to evaluate who is receiving funding from the NIH for topics relevant to voice disorders, and further describe temporal trends in grants awarded. METHODS: The NIH RePORTER database was searched for grants relevant to voice disorders. Data were further organized by PI specialty, academic department, and funding totals. Furthermore, PI scholarly impact, as measured by the h-index, was calculated. RESULTS: A total of 830 funded fiscal years (for 232 unique projects) totaling $203 million have supported projects examining voice disorders. A plurality of projects (32.8%) was awarded to PIs in otolaryngology departments, followed by 17.2% to speech pathology/communication sciences departments. Although year-to-year variation was noted, otolaryngology departments received approximately 15% of funding annually. Funded otolaryngologists had similar scholarly impact values to individuals in other specialties. CONCLUSIONS: The study of voice disorders involves an interdisciplinary approach, as PIs in numerous specialties receive NIH funding support. As they receive a considerable proportion of this funding and had similar h-indices compared to other specialties involved, otolaryngologists have just as much scholarly impact despite being a smaller specialty. As speech and language pathologists also comprised a significant proportion of individuals in this analysis, enhanced cooperation and encouragement of interdisciplinary scholarly initiatives may be beneficial.

Delayed otolaryngology referral for voice disorders increases health care costs.

BACKGROUND: Despite the accepted role of laryngoscopy in assessing patients with laryngeal/voice disorders, controversy surrounds its timing. This study sought to determine how increased time from first primary care to first otolaryngology outpatient visit affected the health care costs of patients with laryngeal/voice disorders. METHODS: Retrospective analysis of a large, national administrative claims database was performed. Patients had an International Classification of Diseases, 9(th) Revision-coded diagnosis of a laryngeal/voice disorder; initially saw a primary care physician and, subsequently, an otolaryngologist as outpatients; and provided 6 months of follow-up data after the first otolaryngology evaluation. The outpatient health care costs accrued from the first primary care outpatient visit through the 6 months after the first otolaryngology outpatient visit were determined. RESULTS: There were 260,095 unique patients who saw a primary care physician as an outpatient for a laryngeal/voice disorder, with 8999 (3.5%) subsequently seeing an otolaryngologist and with 6 months postotolaryngology follow-up data. A generalized linear regression model revealed that, compared with patients who saw an otolaryngologist ≤1 month after the first primary care visit, patients in the >1-month and ≤3-months and >3-months time periods had relative mean cost increases of $271.34 (95% confidence interval $115.95-$426.73) and $711.38 (95% confidence interval $428.43-$993.34), respectively. CONCLUSIONS: Increased time from first primary care to first otolaryngology evaluation is associated with increased outpatient health care costs. Earlier otolaryngology examination may reduce health care expenditures in the evaluation and management of patients with laryngeal/voice disorders.

A portable high-speed camera system for vocal fold examinations.

AIM: In this article, we present a new portable low-cost system for high-speed examinations of the vocal folds. Analysis of glottal vibratory parameters from the high-speed recordings is compared with videostroboscopic recordings. METHODS AND RESULTS: The high-speed system is built around a Fastec 1 monochrome camera, which is used with newly developed software, High-Speed Studio (HSS). The HSS has options for video/image recording, contains a database, and has a set of analysis options. The Fastec/HSS system has been used clinically since 2011 in more than 2000 patient examinations and recordings. The Fastec 1 camera has sufficient time resolution (≥4000 frames/s) and light sensitivity (ISO 3200) to produce images for detailed analyses of parameters pertinent to vocal fold function. The camera can be used with both rigid and flexible endoscopes. The HSS software includes options for analyses of glottal vibrations, such as kymogram, phase asymmetry, glottal area variation, open and closed phase, and angle of vocal fold abduction. It can also be used for separate analysis of the left and vocal fold movements, including maximum speed during opening and closing, a parameter possibly related to vocal fold elasticity. A blinded analysis of 32 patients with various voice disorders examined with both the Fastec/HSS system and videostroboscopy showed that the high-speed recordings were significantly better for the analysis of glottal parameters (eg, mucosal wave and vibration asymmetry). CONCLUSIONS: The monochrome high-speed system can be used in daily clinical work within normal clinical time limits for patient examinations. A detailed analysis can be made of voice disorders and laryngeal pathology at a relatively low cost.

Comparison of quality of life between voice rehabilitated and nonrehabilitated laryngectomies in a developing world community.

CONCLUSIONS: Quality of life (QOL) scores were significantly higher among voice rehabilitated patients although this was accompanied by significant immediate and long-term morbidity and a cost implication for the patient. OBJECTIVE: We present a prospective and cross-over study of overall QOL and morbidity related to voice restoration in laryngectomees. METHODS: The EORTC QOL questionnaire (QLQ-C30 and QLQ-H&N-35) was distributed among all the consenting patients alive after laryngectomy from January 2008 to October 2009. In patients who had secondary voice rehabilitation, post-rehabilitation QOL scores were collected separately. Comparison of QOL between the non-rehabilitated and rehabilitated cohorts was done and a cross-over study of pre-rehabilitation and post-rehabilitation scores were done in the second cohort. RESULTS: A total of 113 patients were studied. QOL scores were significantly higher among voice rehabilitated patients.

[The teachers health damage and pension related to occupational voice disease]. / Uszczerbek na zdrowiu i renta z tytulu choroby zawodowej narzadu glosu u nauczycieli.

The current regulations allow in special cases for the acknowledgement of the occupational disease among teachers who suffer from voice disorders. The physician who acts as the adjudicator in ZUS (National Insurance System) usually consults a phoniatrician and determines the percent of the permanent or long-term health damage, which can vary between 10-40%. The aim of the paper was to analyze the evidence which is taken into consideration while determining the percent of health damage and granting the occupational disease pension. The authors present proposition in detail the rules which govern the process of health damage calculation due to advancement of voice disorders, which can be very useful to adjudicating physicians in government and commercial insurance companies.