Association between Anxiety, Type A Personality, and Treatment Outcome of Dysphonia due to Benign Causes

Abstract

Objective Dysphonia has been linked to psychosocial factors such as anxiety and personality type. The aim of this study is to determine whether these factors also affect the treatment outcome of benign dysphonia. Study Design Prospective case series. Setting Voice clinic of a tertiary otolaryngology clinic. Subjects and Methods Thirty-seven patients diagnosed with benign dysphonia over a 3-month period were included. Demographic data, the Voice Handicap Index–10 (VHI-10), Reflux Symptom Index (RSI), Clinical Anxiety Scale (CAS), and Bortner Personality Scale were recorded at presentation. After a period of treatment with lifestyle advice, proton pump inhibitors, and/or speech therapy, the VHI-10 and RSI were repeated. Results After standard dysphonia treatment, 18 patients who reported complete recovery were found to be significantly less anxious (lower CAS scores) than those who did not recover completely ( P = .023). However, there was no significant difference in number of complete recoveries between patients of personality types A and B ( P > .05). Multivariate regression showed that higher CAS scores had a negative influence on the amount of improvement of VHI-10 ( P = .026) but had no impact on RSI ( P = .148). Again, personality type had no influence on either RSI or VHI-10 improvement (both P > .05). An additional factor, older age, was found to predict negatively for the amount of RSI improvement ( P = .017), but no other predictive variables were identified. Conclusion This is the first study to show that psychosomatic factors may affect treatment outcome in patients with dysphonia due to benign causes. The benefit of adjunctive psycho-cognitive measures warrants further investigation.