Anxiety and Self-Perceived Voice Assessments in Patients With Primary Muscle Tension Dysphonia and Healthy Speakers: A Comparative and Correlative Study

Abstract

OBJECTIVES: Limited research has examined anxiety in muscle tension dysphonia (MTD). This study aimed to compare anxiety levels between primary MTD patients and healthy speakers. Additionally, it explored self-perceived voice characteristics and their relationship with anxiety in both groups. METHODS: A total of 223 participants were recruited, including 120 primary MTD patients and 103 healthy speakers. Anxiety levels and severity were assessed using the Beck Anxiety Inventory (BAI). Self-perceived voice assessments, including voice self-assessment, vocal effort, vocal tract discomfort (VTD), vocal fatigue index (VFI), and voice-related pain scale (VRPS), were conducted to compare self-voice perceptions between the two groups. Additionally, correlations between anxiety and self-perceived voice measures were analyzed. RESULTS: The mean BAI score was significantly higher in patients than in healthy speakers, with a weak effect size (P = 0.0001, eta(2) = 0.122). While most participants in both groups had mild anxiety, anxiety severity was significantly associated with MTD status (P = 0.0001). Significant differences were found between the two groups in voice self-assessment (P = 0.0001) and in vocal effort, VTD, VFI, and VRPS scores (P < 0.05). The Bonferroni correction (alpha = 0.007) indicated significant positive correlations for the VTD frequency (r = 0.34, P = 0.001) and the VTD severity (r = 0.34, P = 0.001) in the healthy speakers. Comparison with patients showed that three measures (all positive) were significant in the patient group. Comparison using Fisher's z tests revealed no statistically significant differences between two groups for any individual measure (all > 0.05). CONCLUSION: Given the higher anxiety levels in primary MTD patients compared with healthy individuals, a psychogenic or multidisciplinary approach can be integrated into their assessment and voice therapy. The findings should be interpreted with consideration of the absence of additional tools for anxiety assessment and the presence of disordered control groups.