Prevalence of Self-Reported Voice Concerns and Associated Risk Markers in a Nonclinical Sample of Military Service Members

Perry, Trevor T.; Brungart, Douglas S.; Myers, Jennifer Rae; Cord, Laura L.; Solomon, Nancy Pearl

doi:10.1044/2023_jslhr-23-00150

Prevalence of Self-Reported Voice Concerns and Associated Risk Markers in a Nonclinical Sample of Military Service Members

Journal Article · 13 September 2023 · Journal of Speech, Language, and Hearing Research

DOI:https://doi.org/10.1044/2023_jslhr-23-00150· OSTI ID:2425770

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National Military Audiology &, Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD; Oak Ridge Institute for Science and Education, APHC Research Participation Program, TN; National Center for Rehabilitative Auditory Research, VA Portland Health Care System, OR
National Military Audiology &, Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD
National Military Audiology &, Speech Pathology Center, Walter Reed National Military Medical Center, Bethesda, MD

Introduction:

Difficult communication environments are common in military settings, and effective voice use can be critical to mission success. This study aimed to estimate the prevalence of self-reported voice disorders among U.S. military service members and to identify factors that contribute to their voice concerns.

Method:

A nonclinical sample of 4,123 active-duty service members was recruited across Department of Defense hearing conservation clinics. During their required annual hearing evaluation, volunteers provided responses to voice-related questions including a slightly adapted version of the Voice Handicap Index-10 (VHI-10) as part of a larger survey about communication issues. Changepoint detection was applied to age and years of service to explore cohort effects in the reporting of voice concerns. Logistic regression analyses examined multiple available factors related to communication to identify factors associated with abnormal results on the VHI-10.

Results:

Among the respondents, 41% reported experiencing vocal hoarseness or fatigue at least several times per year, and 8.2% (n= 336) scored above the recommended abnormal cut-point value of 11 on the VHI-10. Factors independently associated with the greatest risk for self-reported voice concerns were sex (female), cadmium exposure, vocal demands (the need for a strong, clear voice), and auditory health measures (frequency of experiencing temporary threshold shifts; self-reported hearing difficulties).

Conclusions:

Based on self-reported voice concerns and false negative rates reported in the literature, the prevalence of dysphonia in a large sample of active-duty service members is estimated to be 11.7%, which is higher than that in the general population. Certain predictors for voice concerns were expected based on previous literature, like female sex and voice use, but frequency of temporary threshold shifts and exposure to cadmium were surprising. The strong link between voice and auditory problems has particular implications regarding the need for effective communication in high-noise military and other occupational environments.

Research Organization:: Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN (United States)

Sponsoring Organization:: USDOE Office of Science (SC)

DOE Contract Number:: SC0014664

OSTI ID:: 2425770

Journal Information:: Journal of Speech, Language, and Hearing Research, Journal Name: Journal of Speech, Language, and Hearing Research Journal Issue: 9 Vol. 66; ISSN 1092-4388

Country of Publication:: United States

Language:: English

References (71)

Environmental Cadmium and Lead Exposures and Hearing Loss in U.S. Adults: The National Health and Nutrition Examination Survey, 1999 to 2004 Choi, Yoon-Hyeong; Hu, Howard; Mukherjee, Bhramar Environmental Health Perspectives, Vol. 120, Issue 11 https://doi.org/10.1289/ehp.1104863	journal	November 2012
Optimal Detection of Changepoints With a Linear Computational Cost Killick, R.; Fearnhead, P.; Eckley, I. A. Journal of the American Statistical Association, Vol. 107, Issue 500 https://doi.org/10.1080/01621459.2012.737745	journal	September 2012
Voice Disorders in the General Population: Prevalence, Risk Factors, and Occupational Impact Roy, Nelson; Merrill, Ray M.; Gray, Steven D. The Laryngoscope, Vol. 115, Issue 11 https://doi.org/10.1097/01.mlg.0000179174.32345.41	journal	November 2005
Gender differences affecting vocal health of women in vocally demanding careers Hunter, Eric J.; Tanner, Kristine; Smith, Marshall E. Logopedics Phoniatrics Vocology, Vol. 36, Issue 3 https://doi.org/10.3109/14015439.2011.587447	journal	July 2011
Updating and Refining Prevalence Rates of Traumatic Brain Injury–Related Communication Disorders Among Post-9/11 Veterans: A Chronic Effects of Neurotrauma Consortium Study Norman, Rocío S.; Swan, Alicia A.; Jenkins, Angela Perspectives of the ASHA Special Interest Groups, Vol. 6, Issue 5 https://doi.org/10.1044/2020_PERSP-20-00011	journal	October 2021
Self‐reported impact of dysphonia in a primary care population: An epidemiological study Cohen, Seth M. The Laryngoscope, Vol. 120, Issue 10 https://doi.org/10.1002/lary.21058	journal	September 2010
Occupational risk factors and voice disorders Vilkman, Erkki Logopedics Phoniatrics Vocology, Vol. 21, Issue 3-4 https://doi.org/10.3109/14015439609098881	journal	January 1996
Presbyphonia Sauder, Cara; Merati, Albert L. Perspectives of the ASHA Special Interest Groups, Vol. 3, Issue 3 https://doi.org/10.1044/persp3.SIG3.19	journal	January 2018
The Prevalence and Impact of Voice Problems in Nonprofessional Voice Users: Preliminary Findings Sheyona, Valson; Devadas, Usha Journal of Voice, Vol. 36, Issue 3 https://doi.org/10.1016/j.jvoice.2020.06.010	journal	May 2022
Confounding and collinearity in regression analysis: a cautionary tale and an alternative procedure, illustrated by studies of British voting behaviour Johnston, Ron; Jones, Kelvyn; Manley, David Quality & Quantity, Vol. 52, Issue 4 https://doi.org/10.1007/s11135-017-0584-6	journal	November 2017
The Cutoff Point and Diagnostic Accuracy of the Voice Handicap Index in Cantonese-Speaking Population Ng, Eugenie; Law, Thomas; Tang, Eric C. -H. Journal of Voice, Vol. 35, Issue 2 https://doi.org/10.1016/j.jvoice.2020.09.021	journal	March 2021
Korean survey data reveals an association of chronic laryngitis with tinnitus in men Ban, Myung Jin; Kim, Won Shik; Park, Ki Nam PLOS ONE, Vol. 13, Issue 1 https://doi.org/10.1371/journal.pone.0191148	journal	January 2018
Exposure to cadmium and head and neck cancers: a meta-analysis of observational studies Rezapour, Maysam; Rezapour, Habib Allah; Chegeni, Maryam Reviews on Environmental Health, Vol. 36, Issue 4 https://doi.org/10.1515/reveh-2020-0109	journal	February 2021
Validation of the Voice Handicap Index by Assessing Equivalence of European Translations Verdonck-de Leeuw, I. M.; Kuik, D. J.; De Bodt, M. Folia Phoniatrica et Logopaedica, Vol. 60, Issue 4 https://doi.org/10.1159/000127836	journal	January 2008
Correlation of Otologic Complaints in Soldiers With Speech Disorders After Traumatic Brain Injury Dion, Gregory R.; Miller, Courtney L.; O’Connor, Peter D. Journal of Voice, Vol. 28, Issue 1 https://doi.org/10.1016/j.jvoice.2013.08.005	journal	January 2014
Tobacco, but Neither Cannabis Smoking Nor Co-Drug Use, Is Associated With Hearing Loss in the National Health and Nutrition Examination Survey, 2011 to 2012 and 2015 to 2016 Baiduc, Rachael R.; Sun, Joshua W.; Spankovich, Christopher Ear & Hearing, Vol. 43, Issue 5 https://doi.org/10.1097/AUD.0000000000001219	journal	April 2022
Association of total cancer and lung cancer with environmental exposure to cadmium: the meta-analytical evidence Nawrot, Tim S.; Martens, Dries S.; Hara, Azusa Cancer Causes & Control, Vol. 26, Issue 9 https://doi.org/10.1007/s10552-015-0621-5	journal	June 2015
Chronic lead exposure induces cochlear oxidative stress and potentiates noise-induced hearing loss Jamesdaniel, Samson; Rosati, Rita; Westrick, Judy Toxicology Letters, Vol. 292 https://doi.org/10.1016/j.toxlet.2018.05.004	journal	August 2018
Cadmium, obesity, and education, and the 10‐year incidence of hearing impairment: The beaver dam offspring study Dalton, Dayna S.; Schubert, Carla R.; Pinto, Alex The Laryngoscope, Vol. 130, Issue 6 https://doi.org/10.1002/lary.28244	journal	August 2019
Voice Handicap Index in Persian Speakers with Various Severities of Hearing Loss Aghadoost, Ozra; Moradi, Negin; Dabirmoghaddam, Payman Folia Phoniatrica et Logopaedica, Vol. 68, Issue 5 https://doi.org/10.1159/000455230	journal	January 2016
Prevalence and causes of dysphonia in a large treatment‐seeking population Cohen, Seth M.; Kim, Jaewhan; Roy, Nelson The Laryngoscope, Vol. 122, Issue 2 https://doi.org/10.1002/lary.22426	journal	January 2012
Relationship Between Subjective Reports of Temporary Threshold Shift and the Prevalence of Hearing Problems in Military Personnel Brungart, Douglas S.; Barrett, Mary E.; Schurman, Jaclyn Trends in Hearing, Vol. 23 https://doi.org/10.1177/2331216519872601	journal	January 2019
Traumatic brain injury in veterans of the wars in Iraq and Afghanistan: Communication disorders stratified by severity of brain injury Norman, Rocío S.; Jaramillo, Carlos A.; Amuan, Megan Brain Injury, Vol. 27, Issue 13-14 https://doi.org/10.3109/02699052.2013.834380	journal	October 2013
A computationally efficient nonparametric approach for changepoint detection Haynes, Kaylea; Fearnhead, Paul; Eckley, Idris A. Statistics and Computing, Vol. 27, Issue 5 https://doi.org/10.1007/s11222-016-9687-5	journal	July 2016
Voice Disorders in Teachers and the General Population Roy, Nelson; Merrill, Ray M.; Thibeault, Susan Journal of Speech, Language, and Hearing Research, Vol. 47, Issue 3 https://doi.org/10.1044/1092-4388(2004/042)	journal	June 2004
The VHI-10 and VHI Item Reduction Translations—Are we all Speaking the Same Language? Gilbert, Mark R.; Gartner-Schmidt, Jackie L.; Rosen, Clark A. Journal of Voice, Vol. 31, Issue 2 https://doi.org/10.1016/j.jvoice.2016.07.016	journal	March 2017
Prevalence, Characteristics and Impact of Dysphonia in US Marine Corps Drill Instructors Spellman, Joseph; Coulter, Michael; Roth, Carole Journal of Voice, Vol. 34, Issue 5 https://doi.org/10.1016/j.jvoice.2019.02.015	journal	September 2020
Hearing loss associated with US military combat deployment Wells, TimothyS; Seelig, AmberD; Ryan, MargaretA. K. Noise and Health, Vol. 17, Issue 74 https://doi.org/10.4103/1463-1741.149574	journal	January 2015
Estimated Prevalence of Functional Hearing Difficulties in Blast-Exposed Service Members With Normal to Near–Normal-Hearing Thresholds Grant, Ken W.; Kubli, Lina R.; Phatak, Sandeep A. Ear & Hearing, Vol. 42, Issue 6 https://doi.org/10.1097/AUD.0000000000001067	journal	June 2021
A dose-response analysis and quantitative assessment of lung cancer risk and occupational cadmium exposure Stayner, Leslie; Smith, Randall; Thun, Michael Annals of Epidemiology, Vol. 2, Issue 3 https://doi.org/10.1016/1047-2797(92)90052-R	journal	May 1992
Presbylarynx: Is it Possible to Predict Glottal Gap by Cut-Off Points in Auto-Assessment Questionnaires? Santos, Mariline; Sousa, Francisco; Azevedo, Sara Journal of Voice, Vol. 37, Issue 2 https://doi.org/10.1016/j.jvoice.2020.12.013	journal	March 2023
Vocal Behavior in Environmental Noise: Comparisons Between Work and Leisure Conditions in Women With Work-related Voice Disorders and Matched Controls Szabo Portela, Annika; Granqvist, Svante; Ternström, Sten Journal of Voice, Vol. 32, Issue 1 https://doi.org/10.1016/j.jvoice.2017.04.010	journal	January 2018
VHI-10 Scores in a Treatment-Seeking Population With Dysphonia Timmons Sund, Lauren; Collum, J. Austin; Bhatt, Neel K. Journal of Voice, Vol. 37, Issue 2 https://doi.org/10.1016/j.jvoice.2020.12.017	journal	March 2023
Voice Disorders in Teachers. A Review Martins, Regina Helena Garcia; Pereira, Eny Regina Bóia Neves; Hidalgo, Caio Bosque Journal of Voice, Vol. 28, Issue 6 https://doi.org/10.1016/j.jvoice.2014.02.008	journal	November 2014
The Effects of Cadmium Toxicity Genchi, Giuseppe; Sinicropi, Maria Stefania; Lauria, Graziantonio International Journal of Environmental Research and Public Health, Vol. 17, Issue 11 https://doi.org/10.3390/ijerph17113782	journal	May 2020
Prevalence, Severity, Exposures, and Treatment Patterns of Tinnitus in the United States Bhatt, Jay M.; Lin, Harrison W.; Bhattacharyya, Neil JAMA Otolaryngology–Head & Neck Surgery, Vol. 142, Issue 10 https://doi.org/10.1001/jamaoto.2016.1700	journal	October 2016
Evaluation of the effects of exposure to organic solvents and hazardous noise among US Air Force Reserve personnel Hughes, Hayley; Hunting, KatherineL Noise and Health, Vol. 15, Issue 67 https://doi.org/10.4103/1463-1741.121224	journal	January 2013
The Effect of Hearing Impairment on the Vocal Characteristics of Older People Weatherley, Cherisse C.; Worrall, Linda E.; Hickson, Louise M. H. Folia Phoniatrica et Logopaedica, Vol. 49, Issue 2 https://doi.org/10.1159/000266439	journal	January 1997
Tinnitus and Hearing Survey: A Screening Tool to Differentiate Bothersome Tinnitus From Hearing Difficulties Henry, James A.; Griest, Susan; Zaugg, Tara L. American Journal of Audiology, Vol. 24, Issue 1 https://doi.org/10.1044/2014_AJA-14-0042	journal	March 2015
Cumulative lead exposure and age-related hearing loss: The VA Normative Aging Study Park, Sung Kyun; Elmarsafawy, Sahar; Mukherjee, Bhramar Hearing Research, Vol. 269, Issue 1-2 https://doi.org/10.1016/j.heares.2010.07.004	journal	October 2010
Speech audiometry in noise: SNR Loss per age-group in normal hearing subjects Decambron, M.; Leclercq, F.; Renard, C. European Annals of Otorhinolaryngology, Head and Neck Diseases, Vol. 139, Issue 2 https://doi.org/10.1016/j.anorl.2021.05.001	journal	March 2022
Prevalence of and Risk Factors for Tinnitus and Tinnitus-Related Handicap in a College-Aged Population Bhatt, Ishan Sunilkumar Ear & Hearing, Vol. 39, Issue 3 https://doi.org/10.1097/AUD.0000000000000503	journal	May 2018
Long-Time Voice Accumulation During Work, Leisure, and a Vocal Loading Task in Groups With Different Levels of Functional Voice Problems Whitling, Susanna; Lyberg-Åhlander, Viveka; Rydell, Roland Journal of Voice, Vol. 31, Issue 2 https://doi.org/10.1016/j.jvoice.2016.08.008	journal	March 2017
Burn Pit Exposure Is Associated With Increased Sinonasal Disease Hill, Christopher J.; Meyer, Charles D.; McLean, James E. Journal of Occupational & Environmental Medicine, Vol. 64, Issue 8 https://doi.org/10.1097/JOM.0000000000002551	journal	June 2022
Populations in the U.S. workforce who rely on voice as a primary tool of trade: a preliminary report Titze, Ingo R.; Lemke, Julie; Montequin, Doug Journal of Voice, Vol. 11, Issue 3 https://doi.org/10.1016/S0892-1997(97)80002-1	journal	September 1997
Characterization of Voice Disorders in Deployed and Nondeployed US Army Soldiers Dion, Gregory R.; Miller, Courtney L.; Ramos, Rosemarie G. Journal of Voice, Vol. 27, Issue 1 https://doi.org/10.1016/j.jvoice.2012.08.001	journal	January 2013
The effects of excessive vocalization on acoustic and videostroboscopic measures of vocal fold condition Mann, Eric A.; McClean, Michael D.; Gurevich-Uvena, Joyce Journal of Voice, Vol. 13, Issue 2 https://doi.org/10.1016/S0892-1997(99)80035-6	journal	June 1999
Voice disorders and associated risk markers among young adults in the United States Bainbridge, Kathleen E.; Roy, Nelson; Losonczy, Katalin G. The Laryngoscope, Vol. 127, Issue 9 https://doi.org/10.1002/lary.26465	journal	December 2016
Characterization of Vocal Fold Pathology in Military Drill Instructors Duvall, Amber; Dion, Gregory R. Journal of Voice, Vol. 37, Issue 6 https://doi.org/10.1016/j.jvoice.2021.05.013	journal	November 2023
Utility of the Voice Handicap Index as an Indicator of Postthyroidectomy Voice Dysfunction Solomon, Nancy Pearl; Helou, Leah B.; Henry, Leonard R. Journal of Voice, Vol. 27, Issue 3 https://doi.org/10.1016/j.jvoice.2012.10.012	journal	May 2013
Perception of One’s Own Voice After Hearing-Aid Fitting for Naive Hearing-Aid Users and Hearing-Aid Refitting for Experienced Hearing-Aid Users Hengen, Johanna; Hammarström, Inger L.; Stenfelt, Stefan Trends in Hearing, Vol. 24 https://doi.org/10.1177/2331216520932467	journal	January 2020
The choice of methods in determining the optimal cut-off value for quantitative diagnostic test evaluation Hajian-Tilaki, Karimolla Statistical Methods in Medical Research, Vol. 27, Issue 8 https://doi.org/10.1177/0962280216680383	journal	July 2017
TabSINT: open-source mobile software for distributed studies of hearing Shapiro, Marc L.; Norris, James A.; Wilbur, Jed C. International Journal of Audiology, Vol. 59, Issue sup1 https://doi.org/10.1080/14992027.2019.1698776	journal	December 2019
Tinnitus with a normal audiogram: Relation to noise exposure but no evidence for cochlear synaptopathy Guest, Hannah; Munro, Kevin J.; Prendergast, Garreth Hearing Research, Vol. 344 https://doi.org/10.1016/j.heares.2016.12.002	journal	February 2017
Surveyed Reasons for Not Seeking Medical Care Regarding Musculoskeletal Injury Symptoms in US Army Trainees Cohen, Bruce S.; Pacheco, Brooke M.; Foulis, Stephen A. Military Medicine, Vol. 184, Issue 5-6 https://doi.org/10.1093/milmed/usy414	journal	January 2019
Self-Reported Health Care Avoidance Behavior in U.S. Military Pilots Related to Fear for Loss of Flying Status Hoffman, William R.; Aden, James K.; Barbera, Daniel Military Medicine, Vol. 188, Issue 3-4 https://doi.org/10.1093/milmed/usac311	journal	October 2022
The effect of hearing protection worn by talker and/or target listener on speech production in quiet and noise Vaziri, Ghazaleh; Giguère, Christian; Dajani, Hilmi R. The Journal of the Acoustical Society of America, Vol. 152, Issue 3 https://doi.org/10.1121/10.0013895	journal	September 2022
Prevalence of Voice Disorders in the General Population, Based on the Stockholm Public Health Cohort Lyberg-Åhlander, Viveka; Rydell, Roland; Fredlund, Peeter Journal of Voice, Vol. 33, Issue 6 https://doi.org/10.1016/j.jvoice.2018.07.007	journal	November 2019
changepoint : An R Package for Changepoint Analysis Killick, Rebecca; Eckley, Idris A. Journal of Statistical Software, Vol. 58, Issue 3 https://doi.org/10.18637/jss.v058.i03	journal	January 2014
The prevalence of voice problems among adults in the United States Bhattacharyya, Neil The Laryngoscope, Vol. 124, Issue 10 https://doi.org/10.1002/lary.24740	journal	May 2014
Normative Values for the Voice Handicap Index-10 Arffa, Rachel E.; Krishna, Priya; Gartner-Schmidt, Jacqueline Journal of Voice, Vol. 26, Issue 4 https://doi.org/10.1016/j.jvoice.2011.04.006	journal	July 2012
Smoking, Smoking Cessation, and the Risk of Hearing Loss: Japan Epidemiology Collaboration on Occupational Health Study Hu, Huanhuan; Sasaki, Naoko; Ogasawara, Takayuki Nicotine & Tobacco Research, Vol. 21, Issue 4 https://doi.org/10.1093/ntr/nty026	journal	March 2018
Vocal Effects in Military Students Submitted to an Intense Recruit Training: A Pilot Study Nascimento, Camila Lima; Constantini, Ana Carolina; Mourão, Lúcia Figueiredo Journal of Voice, Vol. 30, Issue 1 https://doi.org/10.1016/j.jvoice.2015.03.005	journal	January 2016
A Modified Bayes Information Criterion with Applications to the Analysis of Comparative Genomic Hybridization Data Zhang, Nancy R.; Siegmund, David O. Biometrics, Vol. 63, Issue 1 https://doi.org/10.1111/j.1541-0420.2006.00662.x	journal	October 2006
Cigarette Smoking and Hearing Loss Cruickshanks, Karen J.; Klein, Ronald; Klein, Barbara E. K. JAMA, Vol. 279, Issue 21 https://doi.org/10.1001/jama.279.21.1715	journal	June 1998
Symptoms of vocal attrition in women army instructors and new recruits: Results from a survey Sapir, Shimon; Atias, Joseph; Shahar, Amnon The Laryngoscope, Vol. 100, Issue 9 https://doi.org/10.1288/00005537-199009000-00013	journal	September 1990
Patient reported voice handicap and auditory-perceptual voice assessment outcomes in patients with COVID-19 Tahir, Emel; Kavaz, Esra; Çengel Kurnaz, Senem Logopedics Phoniatrics Vocology, Vol. 48, Issue 2 https://doi.org/10.1080/14015439.2021.2011958	journal	December 2021
Cross-cultural Adaptation and Validation of the Greek Voice Handicap Index-10 (GVHI-10) With Additional Receiver Operating Characteristic Analysis Tafiadis, Dionysios; Helidoni, Meropi E.; Chronopoulos, Spyridon K. Journal of Voice, Vol. 34, Issue 2 https://doi.org/10.1016/j.jvoice.2018.09.009	journal	March 2020
A Comparison of Dysphonia Severity Index in Female Teachers With and Without Voice Complaints in Elementary Schools of Tehran, Iran Aghadoost, Ozra; Amiri-Shavaki, Younes; Moradi, Negin Nursing and Midwifery Studies, Vol. 1, Issue 3 https://doi.org/10.5812/nms.9904	journal	March 2013
Efficiency and Cutoff Values of Self-Assessment Instruments on the Impact of a Voice Problem Behlau, Mara; Madazio, Glaucya; Moreti, Felipe Journal of Voice, Vol. 30, Issue 4 https://doi.org/10.1016/j.jvoice.2015.05.022	journal	July 2016
Development and Validation of the Voice Handicap Index‐10 Rosen, Clark A.; Lee, Annie S.; Osborne, Jamie The Laryngoscope, Vol. 114, Issue 9 https://doi.org/10.1097/00005537-200409000-00009	journal	September 2004

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