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Two-thirds of Americans with voice problems don't seek medical care either because they don't know treatment is available or because they think the problem will just go away, according to a new study conducted at the Duke Voice Care Center.

That's concerning, says Seth Cohen, MD, an otolaryngologist at Duke. "Voice disorders aren't benign nuisances that just go away. They are symptoms of a range of medical conditions from allergies to cancer. When caught early, the right treatment can make a big difference. Left untreated, they can become chronic problems that previous studies show have a major impact on quality-of-life issues, including an increased risk of depression. This study helps us understand the barriers preventing people from seeking treatment when there is so much at stake."

An estimated 20 million Americans have dysphonia, the clinical umbrella term for a hoarse or raspy voice that can cause pain when speaking and make it difficult to communicate effectively.

Previous data link dysphonia to decreased work productivity and social isolation. Patients also incur financial burdens including rising health care costs. Overall, economic losses have been estimated in the billions.

"Dysphonia affects everyone at every age," says Cohen, author of the study that appears online in the journal Laryngoscope. It will appear in the October issue. "You don't have to have a vocally demanding job to suffer."

There's a host of conditions that lead to dysphonia, including tobacco, alcohol and caffeine use, certain medications, voice overuse/misuse, hearing loss, dry mouth and reflux.

Dysphonia can also be sign of something more serious, like asthma, lung disease, Parkinson's or laryngneal cancer.

"You have no idea what is causing the problem or what the appropriate treatment should be until an evaluation is performed," says Cohen. That requires the use of a laryngoscope that threads a camera down the throat so doctors can determine the medical cause.

Few dysphonia patients go that route.

In the Duke study of 789 patients in a primary care network, nearly 30 percent (29.1 percent) had dysphonia at least once in their lifetime; 4.3 percent had it for more four weeks. More than half (54 percent) of those with current dysphonia had missed at least one day of work as a result of their condition. More than three-quarters (77.9 percent) of patients who had dysphonia more than once had never received treatment.

When asked why they didn't seek treatment:

  • 30.4 percent did not know options for treatments were available;
  • 33.3 percent thought the problem would go away on its own;
  • 26.1 percent didn't seek care because their physician didn't asked about vocal problems;
  • 14.5 percent thought dysphonia was due to aging;
  • 7.2 percent cited expense and insurance coverage;
  • 4.3 percent cited travel limitations.

Cohen says it's important for patients to understand that vocal disorders can get progressively worse when left alone.

"Patients who don't seek treatment get caught in a vicious cycle. As the problem becomes more chronic, patients seem to be accepting it, but that won't make the situation better," he says.

Rather than take vocal disorders for granted, Cohen stresses, "Patients need to become better advocates for their own health. They should talk to their doctor so they can get appropriately evaluated and a personalized treatment plan can be developed."

This study was funded by the American Academy of Otolaryngology -- Head & Neck Surgery Foundation Health. The authors report no conflicts of interest.