4.1 - Onset of the Vocal Symptoms
Table 13 presents the description made by Group regarding the type of the onset of the vocal symptoms, the knowledge of the date of the onset, and if they had experienced the same vocal symptom in the past.
Considering the type of the onset, both groups of patients with psychogenic and secondary muscle tension voice disorders (PVD and MTVD2) had experienced mostly a progressive course while patients from primary muscle tension voice disorders group (MTVD1) had reported more frequently a sudden start.
TABLE 13
Onset of the Vocal Symptoms by Group: Frequency and Percentage
Type of Onset Date of Onset Past Vocal Symptom
Progressive Sudden No Yes No Yes
PVD (53.8%) 21 (46.2%) 18 (41.0%) 16 (59.0%) 23 28 (7.1%) (28.2%) 11
MTVD1 7 (43.8%) 9 (56.3%) 8 (50.0%) 8 (50.0%) 9 (56.2%) 7 (43.8%)
MTVD2 (64.3%) 18 (35.7%) 10 (57.1%) 16 (42.9%) 12 (78.6%) 22 6 (21.4%)
Abbreviations: MTVD1, Primary Muscle Tension Voice Disorders; MTVD2, Secondary Muscle Tension Voice Disorders; PVD, Psychogenic Voice Disorders.
It is commonly reported that patients with psychogenic voice disorders (PVD) very often indicate the precise date of the beginning of the vocal symptom, which they often associate with a striking event expressed as: “It was 15 days ago, I was talking to a colleague and she suddenly said: you're running out of voice”; “A year ago after a conflict”; “Five years ago during the college internship”; “Ten years ago after talking to a person who told me: I'm only happy when I completely destroy you”. In fact patients with psychogenic voice disorders (PVD) had a better knowledge on the date of the onset of the vocal symptom compared to patients from the two other groups (MTVD1 and MTVD2) (Table 13), but there was no association between Group and the knowledge on the precise date of the onset (χ2 = 1.722, df = 2, p = .423).
As seen in Table 13, nearly half of the patients with primary muscle tension voice disorders (MTVD1) reported a previous experience of similar vocal symptoms in
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percentages that were almost the double than those obtained by the two other groups (PVD and MTVD2). There was no association between Group and similar past vocal symptom experience (χ2 = 2.486, df = 2, p = .288).
4.2 - Vocal Symptoms
Table 14 presents the vocal symptoms experienced by the patients by Group.
Regarding the three groups, the most frequent vocal symptoms were vocal fatigue and intensity changes, and the vocal symptom that was less experienced was aphonia.
For patients with psychogenic voice disorders (PVD), the biggest complaint was vocal fatigue (≈ 97%) closely followed by intensity changes (≈ 92%) and hoarseness (≈ 90%).
The secondary muscle tension voice disorders group (MTVD2) was the group that reported greatest changes in vocal quality: hoarseness (100.0%), intensity changes (100.0%) and vocal fatigue (≈ 93%).
Concerning the group of patients with primary muscle tension voice disorders (MTVD1), vocal fatigue (≈ 88%) continues to be the most frequent as intensity changes (≈ 88%), while hoarseness had a percentage value close to 69%.
TABLE 14
Vocal Symptoms by Group: Frequency and Percentage
Hoarseness Aphonia Vocal fatigue Intensity changes PVD 35 (89.7%) 18 (46.2%) 38 (97.4%) 36 (92.3%)
MTVD1 11 (68.8%) 8 (50.0%) 14 (87.5%) 14 (87.5%)
MTVD2 28 (100.0%) 10 (35.7%) 26 (92.9%) 28 (100.0%)
Abbreviations: MTVD1, Primary Muscle Tension Voice Disorders; MTVD2, Secondary Muscle Tension Voice Disorders; PVD, Psychogenic Voice Disorders.
It was verified that the group with the highest frequency of vocal symptoms was the secondary muscle tension voice disorders group (MTVD2) followed by the psychogenic voice disorders group (PVD). However, patients with primary muscle tension voice disorders (MTVD1) also presented vocal fatigue, intensity changes, hoarseness and even aphonia although in comparatively lower percentages.
With Chi-square test procedure, statistically differences in association between Group and vocal symptoms were found for hoarseness (χ2 = 10.311, df = 2, p = .006).
Table 15 presents descriptive statistics for hoarseness by Group.
All patients with secondary muscle tension voice disorders (MTVD2) had complained about hoarseness while nearly 70% of the patients with primary muscle tension voice disorders (MTVD1) had the same complained.
TABLE 15
Hoarseness by Group: Frequency, Percentage and Adjusted Residual
Hoarseness PVD Frequency (Percentage) 35 (89.7%) Adjusted Residual - .2 MTVD1 Frequency (Percentage) 11 (68.8%) Adjusted Residual - 2.9 MTVD2 Frequency (Percentage) 28 (100.0%) Adjusted Residual 2.3
Abbreviations: MTVD1, Primary Muscle Tension Voice Disorders; MTVD2, Secondary Muscle Tension Voice Disorders; PVD, Psychogenic Voice Disorders.
The analysis of adjusted residual indicates that in the primary muscle tension voice disorders group (MTVD1) there were fewer patients who complain of hoarseness than expected while patients with secondary muscle tension voice disorders (MTVD2) reported more complains of hoarseness than expected.
4.3 - Time Since the Onset of the Vocal Symptoms
Figure 5 represents the time since the onset of at least one vocal symptom. The definition of periods of time was made based on the patient’s report.
In the group of patients with psychogenic voice disorders (PVD) vocal symptoms were more frequently found between two to five years (23.1%) and for three to six months (17.9%).
Patients with primary muscle tension voice disorders (MTVD1) were more often distributed in two time periods, the first was between twelve and eighteen months (31.3%) and the other from one to three months (25.0%).
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In the secondary muscle tension voice disorders group (MTVD2), vocal symptoms had frequently arise between two to five years (39.3%) and for more than ten years (17.9%).
FIGURE 5. - Time since the Onset of the Vocal Symptom by Group.
Abbreviations: MTVD1, Primary Muscle Tension Voice Disorders; MTVD2, Secondary Muscle Tension Voice Disorders; PVD, Psychogenic Voice Disorders
There was a statistically significance in association between Group and the time since the onset of vocal symptoms (χ2 = 27.011, df = 16, p = .041).
Patients with secondary muscle tension voice disorders (MTVD2) presented long symptomatic periods and patients with primary muscle tension voice disorders (MTVD1) had a shorter symptom evolution.
4.4 - Comments made by others about the Patient’s Voice
Patients from the outpatient clinic of the ENT Department frequently reported that others made comments about their voices. The most common comments were: “speaks loud”, “not understood” and “not heard”. It was asked to our patients to identify the one that was most frequently addressed.
Table 16 presents descriptive statistics of the comments that others make about the voice of the patient by Group.
TABLE 16
Comments made by Others about the Patient’s Voice by Group: Frequency, Percentage
and Adjusted Residual
Without Speaks loud Understood Not Heard Not
PVD Frequency Percentage 15 45.5% 7 21.2% 3 9.1% 8 24.2% Adjusted Residual - 1.8 .1 .7 1.9 MTVD1 Frequency Percentage 4 30.8% 5 38.5% 2 15.4% 2 15.4% Adjusted Residual - 2.1 1.7 1.3 .0 MTVD2 Frequency Percentage 22 84.6% 3 11.5% 0 0.0% 1 3.8% Adjusted Residual 3.6 -1.5 - 1.7 - 2.0
Abbreviations: MTVD1, Primary Muscle Tension Voice Disorders; MTVD2, Secondary Muscle Tension Voice Disorders; PVD, Psychogenic Voice Disorders.
There was a statistically significance in association between Group and the comments on patients’ voice done by others (χ2 = 16.163, df = 6, p = .013).
The analysis of adjusted residual revealed that in primary muscle tension voice disorders group (MTVD1) there were less patients without comments about their voices than expected while patients with secondary muscle tension voice disorders (MTVD2) reported more comments about their voices than expected. In this group there were also less patients with the comment “not heard” than expected (Table 16).
4.5 - Current History of Speech Therapy
Table 17 presents the current history of speech therapy in the last six months by Group.
During this period of time, patients from the three groups were attending speech therapy sessions (PVD = 43.6%, MTVD1 = 50.0% and MTVD2 = 57.1%).
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TABLE 17
Current History of Speech Therapy by Group: Frequency and Percentage
Without With
PVD 17 (43.6%) 22 (56.4%)
MTVD1 8 (50.0%) 8 (50.0%)
MTVD2 16 (57.1%) 12 (42.9%)
Abbreviations: MTVD1, Primary Muscle Tension Voice Disorders; MTVD2, Secondary Muscle Tension Voice Disorders; PVD, Psychogenic Voice Disorders.
There was no association between Group and current history of speech therapy (χ2 = .239, df = 2, p = .887).
Table 18 presents the current status on speech therapy by Group.
In the last six months, patients from the three groups received guidance by a speech therapy (PVD = 56.4%, MTVD1 = 50.0% and MTVD2 = 42.9%).
During this period, almost 19% of patients with primary muscle tension voice disorders (MTVD1) had ended their treatments with a speech therapist and patients from this group also disrupted more frequently their treatment (MTVD1 = 6.3%).
Patients with secondary muscle tension voice disorders (MTVD2) did not present treatment dropout.
TABLE 18
Current Status on Speech Therapy by Group: Frequency and Percentage
Keeps Discharged Disengagement
PVD 17 (44.7%) 3 (7.9%) 1 (2.6%)
MTVD1 5 (31.3%) 3 (18.8%) 1 (6.3%)
MTVD2 14 (50.0%) 2 (7.1%) 0 (0.0%)
Abbreviations: MTVD1, Primary Muscle Tension Voice Disorders; MTVD2, Secondary Muscle Tension Voice Disorders; PVD, Psychogenic Voice Disorders.
There was no association between Group and the characteristics and current status on speech therapy (χ2 = 4.139, df = 6, p = .658).
4.6 - Family History of Voice Disorders
The data regarding the prevalence and etiology of voice disorders in the patients’ families was based only on their reports. All information was purely informative because it
had no medical confirmation. These data indicated the perception and some knowledge that each participant had of the existence or not of a voice disorder in his/her family.
4.6.1 - Prevalence
The prevalence of family history of voice disorders in the three groups was nearly one quarter. The group of patients with secondary muscle tension voice disorders (MTVD2 = 21.4%) had more family members with voice disorders compared to the other groups although the incidence in the primary muscle tension voice disorders group was not so comparatively low (MTVD1 = 18.8%).
TABLE 19
Prevalence of Family History of Voice Disorders by Group: Frequency and Percentage
Without With
PVD 35 (89.7%) 4 (10.3%)
MTVD1 13 (81.2%) 3 (18.8%)
MTVD2 22 (78.6%) 6 (21.4%)
Abbreviations: MTVD1, Primary Muscle Tension Voice Disorders; MTVD2, Secondary Muscle Tension Voice Disorders; PVD, Psychogenic Voice Disorders.
There was no association between the prevalence of family history of voice disorders and Group (χ2 = 1.683, df = 2, p = .431). Before this result it was decided to present in the Appendix E the frequency of the diagnoses of voice disorder as well as the identification of the respective family member by Group.