Medical Comorbidities and Behavioral Health in Adolescents With Voice Disorders

Abstract

Importance: Voice problems in adolescents detract from quality of life. Yet it is unknown whether medical history or behavioral health profiles are associated with increased voice disorder risk in this population. Objective: To determine the medical comorbidities, behavioral health profiles, and medication use patterns associated with increased risk for voice disorders in adolescents (age 13-17 years) across the US. Design, setting, and participants: A prospectively performed cross-sectional design was utilized in this survey study. A probability sample of adolescents living across the US was recruited between March and June 2023. Main outcomes and measures: Adolescents were surveyed regarding voice status, medical history, behavioral health diagnoses, and medication use. Multivariable logistic regression was used to identify factors associated with increased prevalence of voice problems. Results: Of 988 adolescents invited to complete the survey, 502 participated (mean [SD] age, 15.2 [1.27] years; 254 male [50.6%]). Factors associated with increased voice problem prevalence in adolescents included a family history of voice disorders (odds ratio [OR], 7.3; 95% CI, 3.2-14.7), cancer (OR, 6.5; 95% CI, 2.9-10.9), diabetes (OR, 3.4; 95% CI, 2.1-5.1), neurological disorders (OR, 3.1; 95% CI, 1.9-5.1), gastrointestinal issues (OR, 2.5; 95% CI, 1.8-3.2), and acid reflux (OR, 2.3; 95% CI, 1.5-3.6). Anxiety (OR, 2.2; 95% CI, 1.8-3.7) and depression (OR, 1.9; 95% CI, 1.5-2.9) were associated with increased voice problems, and voice disorder risk was associated with anxiety severity. Additionally, inhaler use (OR, 1.6; 95% CI, 1.2-2.5), depression/anxiety medications (OR, 3.1; 95% CI, 1.9-4.2), and steroids/hormones (OR, 4.05; 95% CI, 1.9-8.2) were associated with voice problems. Conclusions and relevance: Findings of this survey study suggest that voice problem risk is associated with medical history, behavioral health profile, and medicinal intake. Research is needed to further characterize factors that place adolescents at risk for voice disorders, as well as to determine how these factors may affect treatment.