Patient reported voice outcome in recurrent respiratory papillomatosis

Abstract

Objectives/Hypothesis:To assess the impact of patient reported voice outcome on quality of life and emotional functioning in patients treated for recurrent respiratory papillomatosis (RRP).Study Design:Cross‐sectional.Methods:All adult patients treated for RRP between 1984 and 2008 were asked to participate. Outcome measures were obtained from questionnaires including VHI (Voice Handicap Index), HADS (Hospital Anxiety and Depression Scale), 36‐Item Short Form Health Survey (SF‐36), and Utrechtse Coping List.Results:Out of 45 included patients, 34 (22 males,12 females) participated (76%). Mean age was 52 years (range, 25–85 years). RRP was located only in the larynx in 90% of the cases. Adult onset RRP was diagnosed in 29 cases, juvenile onset RRP in 5. Median number of surgical procedures was five (range, 1–17). In this study cohort, 68% scored above the VHI cutoff point, and 18% had an increased risk for depression or anxiety disorders (HADS). VHI scores were related to age, time between consecutive surgeries, time since last surgery, and passive coping. They were not related to gender, onset of RRP, or location. VHI scores were related to the SF‐36 subscales social functioning (r = −0.43) and mental health (r = −0.43).Conclusions:Patients with RRP often report voice problems in daily life, and this is related to (a passive) coping style, social functioning, and mental health. Psychosocial intervention targeting an adaptive coping style may be beneficial in selected cases. Laryngoscope, 2010

Psychological Distress in Patients with Benign Voice Disorders

“…Laryngeal papillomatosis, VF paralysis and LPR diagnosis achieved the highest anxiety scores in the present study due to the chronic, complicated nature of these disorders when secondary psychological distress might be expected more than primary. These voice disorders are serious and frustrating with life-threatening complications, longterm treatment, and often insufficient treatment outcomes [4,10,12,18] . These factors could lead to secondary psychological distress.…”

“…A gender-adjusted z-score analysis showed similar results for anxiety (40.0% of the Overall, anxiety appeared to be more common for the pooled voice patients set than did depression. According to the literature, elevated states of anxiety as measured by the HADS, which represents generalized anxiety symptoms, are connected with reported trait anxiety (personality traits such as introversion and neuroticism) for the patients with benign voice disorders, especially for those suffering from nonorganic dysphonia [1,4,6,7,9] . Specific personality traits might lead to muscularly inhibited voice production and result in elevated laryngeal tension and primary development of nonorganic dysphonia.…”

“…Psychogenic causes and an increased tension of the intrinsic and extrinsic laryngeal muscles, in response to psychological conflict, anxiety, depression or inhibited psychoemotional expression, are presumed to be one end of the spectrum of possible factors leading to the development of functional voice problems [3] . In addition, advanced laryngeal disorders such as laryngeal cancer and recurrent papillomatosis cause psychological distress, resulting in the formation of a vicious cycle [4,5] . Dysphonic patients frequently report symptoms of psychological distress such as anxiety and depression [6,7] .…”

“…On the whole, the assessment of psychological distress is an important issue, but a major segment of the studies on the frequency of psychological distress among patients with voice disorders is devoted to selected patient groups, e.g. patients with nonorganic dysphonia, while the data on psychological distress in patients with benign VF lesions and tumors or chronic inflammation are sparse and insufficient [4,5,[8][9][10] . Further investigations on how anxiety and depression may distribute across various voice disorders and across genders in a large sample could add more information on the prevalence of psychological distress among dysphonic patients with a wider spectrum of voice disorders and could lead to better treatment options for selected patients.…”

Pediatric Stridor

“…The primary chronic outcome measure of repeated excision is voice quality, and current and future research is oriented toward identifying optimal treatment strategies. 63 Adjuvant therapies include cidofovir and avastin, which have shown success in reducing the frequency of excision and severity of recurrence, respectively. 64,65 There is hope among the otolaryngology community that HPV vaccination, which has become widespread in recent years, could be a bellwether for the future of RRP prevention.…”