Vocal deviation, signs and symptoms, laryngological diagnosis, and their association with self-perception of voice

Araújo, Izamara; Simões-Zenari, Marcia; Neves, Maura; Jacob, Fábio; Nemr, Katia

doi:10.1590/2317-6431-2025-3033pt

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Original Article • Audiol., Commun. Res. 30 • 2025 • https://doi.org/10.1590/2317-6431-2025-3033en linkcopy

Vocal deviation, signs and symptoms, laryngological diagnosis, and their association with self-perception of voice

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose To investigate the association between self-perception of vocal quality and the degree of vocal deviation, signs and symptoms, and laryngological diagnosis.

Methods Cross-sectional, observational, and descriptive study. The sample consisted of 100 individuals of both sexes, with an average age of 38.9 years, users of a university hospital. The General Dysphonia Risk Screening Protocol was applied, which includes a Visual Analog Scale (VAS) for self-assessment of vocal quality. Voices were recorded and a laryngological examination was performed.

Results The average VAS score was 4.13 (mild deviation). From the clinical analysis, it was observed that there was a higher frequency of mild dysphonia and benign laryngeal lesions. Approximately one third presented laryngeal exam without alterations. Self-perception of vocal deviation was associated with signs and symptoms of hoarseness, deep voice and sore throat.

Conclusion The association of self-perception of vocal quality with some vocal signs and symptoms and the lack of association with vocal deviation and the type of laryngeal lesion indicates many particularities in the way each patient perceives his/her alteration, and it is necessary that this perception be expanded for better therapeutic success.

Keywords:
Voice; Voice Quality; Visual analog scale; Self-concept; Dysphonia

	Mean	SD	Median	Min.	Max.
VAS score (vocal self-perception)	4.13	2.80	4.00	0.00	10.00
Overall severity of vocal deviation	36.72	7.15	36.75	22.50	67.00

Symptom	Never		Monthly/ sometimes		Weekly/ almost always		Daily/ always
Symptom	n	%	n	%	n	%	n	%
Vocal fatigue	23	23.00	51	51.00	19	19.00	7	7.00
Itchy throat	27	27.00	39	39.00	31	31.00	3	3.00
Raspy throat	24	24.00	45	45.00	24	24.00	7	7.00
Dry throat	13	13.00	30	30.00	35	35.00	22	22.00
Throat clearing	11	11.00	41	41.00	23	23.00	25	25.00
Cheek biting	28	28.00	39	39.00	23	23.00	10	10.00
Tiredness after meals	41	41.00	19	19.00	21	21.00	19	19.00
Hoarseness	29	29.00	39	39.00	22	22.00	10	10.00
Voice failures/breaks	25	25.00	39	39.00	30	30.00	6	6.00
Difficulty controlling vocal intensity	37	37.00	33	33.00	16	16.00	14	14.00
Sore throat	22	22.00	55	55.00	20	20.00	3	3.00
Shortness of breath	44	44.00	28	28.00	18	18.00	10	10.00
Choking	39	39.00	44	44.00	13	13.00	4	4.00
Need to cough to clear the throat	19	19.00	34	34.00	28	28.00	19	19.00
Sensation of a foreign body in the larynx	43	43.00	39	39.00	11	11.00	7	7.00
Weak voice	45	45.00	34	34.00	14	14.00	7	7.00
Deep voice	48	48.00	29	29.00	13	13.00	10	10.00

Independent variable	b	95% CI	β	95% CI	p-value	R²
Overall severity	0.01	-0.09 – 0.10	0.017	-0.22 – 0.27	0.878	0.000
Vocal fatigue	0.67	-0.37 – 1.74	0.200	-0.11 – 0.52	0.150	0.028
Itchy throat	-0.23	-1.13 – 0.63	-0.070	-0.34 – 0.19	0.613	0.003
Raspy throat	0.48	-0.32 – 1.33	0.149	-0.10 – 0.41	0.193	0.021
Dry throat	0.51	-0.27 – 1.36	0.175	-0.09 – 0.47	0.198	0.020
Throat clearing	-0.21	-0.97 – 0.72	-0.073	-0.34 – 0.25	0.557	0.005
Cheek biting	-0.37	-0.99 – 0.27	-0.124	-0.34 – 0.09	0.226	0.018
Tiredness after meals	0.23	-0.38 – 0.77	0.098	-0.16 – 0.32	0.357	0.011
Hoarseness	1.02	0.39 – 1.52	0.347	0.13 –0.51	0.005*	0.098
Voice failures/breaks	-0.10	-1.09 – 1.06	-0.031	-0.34 – 0.33	0.837	0.001
Difficulty controlling vocal intensity	0.25	-0.30 – 0.82	0.095	-0.11 – 0.31	0.429	0.008
Sore throat	-1.12	-1.91 – -0.25	-0.294	-0.50 – -0.06	0.006*	0.105
Shortness of breath	0.16	-0.69 – 0.74	0.059	-0.25 – 0.27	0.666	0.002
Choking	0.09	-0.69 – 0.96	0.027	-0.20 – 0.28	0.783	0.001
Need to cough	-0.03	-0.60 – 0.42	-0.009	-0.21 – 0.15	0.949	0.000
Sensation of a foreign body in the larynx	-0.05	-0.69 – 0.54	-0.017	-0.22 – 0.17	0.875	0.000
Weak voice	-0.09	-0.98 – 0.85	-0.030	-0.32 – 0.28	0.832	0.001
Deep voice	0.72	-0.04 – 1.30	0.256	-0.02 – 0.46	0.049*	0.050
G2	-0.11	-1.57 – 1.31	-0.017	-0.24 – 0.20	0.884	0.000
G3	-0.59	-2.18 – 1.32	-0.069	-0.25 – 0.15	0.446	0.007
G4	0.69	-1.32 – 2.81	0.067	-0.13 – 0.27	0.458	0.007
G2/G4	0.60	-0.91 – 1.94	0.078	-0.12 – 0.26	0.471	0.006
G4/G3	0.02	-2.06 – 2.02	0.002	-0.22 –0.22	0.991	0.000

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Academia Brasileira de Audiologia Rua Itapeva, 202, conjunto 61, CEP 01332-000, Tel.: (11) 3253-8711 - São Paulo - SP - Brazil
E-mail: revista@audiologiabrasil.org.br

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[1] Subtitle: VAS = Visual Analog Scale; SD = Standard deviation; Min. = Minimum; Max. = Maximum