Prevalence of Vocal Tract Discomfort in the Flemish

Population Without Self-Perceived Voice Disorders

,
*Anke Luyten, *Laura Bruneel, *Iris Meerschman, *Evelien D’haeseleer, †,‡Mara Behlau, *Camille Coffe
and *Kristiane Van Lierde, *Gent, Belgium, and yzS~ao Paulo, Brazil

Summary: Objectives. The main aim of this study was to assess the prevalence of Vocal Tract Discomfort (VTD) in
the Flemish population without self-perceived voice disorders using the VTD scale and to examine the relationship be-
tween vocal load and VTD symptoms. In addition, consistency between the VTD scale and the Voice Handicap Index
(VHI) and the Corporal Pain scale was evaluated.
Methods. A total of 333 participants completed the VTD scale, the VHI, and the Corporal Pain scale. Patient infor-
mation about study and voice-related hobbies (for students), state of (non)professional voice user (for employees),
smoking, shouting, allergy, and voice therapy was taken into account.
Results. A median number of three VTD symptoms was reported, and 88% of the participants showed at least one
symptom of VTD. Dryness (70%), tickling (62%), and lump in the throat (54%) were the most frequently occurring
symptoms. The frequency and severity of VTD were significantly higher in participants who followed voice-related
studies, played a team sport, were part of a youth movement, shouted frequently, and received voice therapy in the
past (P < 0.05). Finally, low correlations were obtained between frequency and severity of the VTD scale and total
VHI score (r ¼ 0.226–0.411) or frequency and intensity of the Corporal Pain scale (r ¼ 0.016–0.408).
Conclusions. The prevalence of VTD is relatively high in the Flemish population without self-perceived voice dis-
orders, although the frequency and severity of the symptoms are rather low. Vocal load seems to influence the frequency
and severity of VTD. Finally, the VTD scale seems to reveal clinically important information that cannot be gathered
from any other protocol.
Key Words: Voice–Vocal Tract Discomfort–Vocal load.

INTRODUCTION symptoms can reveal important information about the patient’s

Quality of life is considered to be of paramount importance in
clinical practice. To assess patients’ quality of life, health
care providers should not only focus on functional status, but
the assessment should cover physical, psychological, social,
as well as spiritual domains of life.1 One of the parameters
that should be included in the assessment of quality of life ac-
cording to The World Health Organization Quality of Life
(WHOQOL) Group1 is ‘‘pain and discomfort.’’ Pain can be
defined as ‘‘an unpleasant sensory and emotional experience
associated with actual or potential tissue damage,’’2 whereas
discomfort is a subjective experience of ‘‘something that causes
one to feel uncomfortable.’’3
Pain and discomfort at the vocal tract are frequently heard com-
plaints of voice patients, but they are not always properly consid-
ered when assessing the patient. The most used instrument for
self-assessment of vocal problems, the Voice Handicap Index
(VHI),4 does not evaluate pain and discomfort itself. Even if
discomfort may not be one of the most common symptoms of a
voice problem, it may cause several maladjustments on the pro-
cess of voice production. Therefore, specific evaluation of these
Accepted for publication April 29, 2015.
L.B. has contributed equally to this study.
From the *Department of Speech, Language and Hearing Sciences, Ghent University,
Gent, Belgium; yDepartamento de Fonoaudiologia, Universidade Federal de S~ao Paulo,
S~ao Paulo, Brazil; and the zCentro de Estudos da Voz - CEV, S~ao Paulo, Brazil.
Address correspondence and reprint requests to Anke Luyten, Department of Speech,
Language and Hearing Sciences, Ghent University, De Pintelaan 185, 2P1, 9000 Gent,
Belgium. E-mail: Anke.Luyten@UGent.be
Journal of Voice, Vol. 30, No. 3, pp. 308-314
0892-1997/$36.00
Ó 2016 The Voice Foundation
http://dx.doi.org/10.1016/j.jvoice.2015.04.017
current status of and the influence of therapy on the patient’s qual-
ity of life. To quantify the severity and frequency of an individ-
ual’s throat discomfort by means of qualitative descriptors,
Mathieson et al5 developed a self-rating Vocal Tract Discomfort
(VTD) scale. This scale has been demonstrated to be a very reli-
able tool with good sensitivity, specificity, and efficiency.6
Few studies have reported on the usefulness of the VTD scale
in diagnosing voice patients. Mathieson et al5 used the VTD
scale to evaluate the effects of laryngeal manual therapy in pa-
tients with muscle tension dysphonia. According to the authors,
this scale is a useful perceptual indicator of sensory changes.
Similarly, Woznicka et al7 concluded that the VTD scale can
successfully be used to monitor the progress in treatment of
occupational voice disorders. Furthermore, Rodrigues et al6
verified the VTD in teachers with and without vocal complaints
and found a correlation between the self-perceived voice and
VTD. Teachers with self-reported voice problems presented
with higher frequencies and greater severity scores of all
VTD symptoms than teachers without complaints. Finally,
Lopes et al8 observed differences in VTD on the basis of the
type of voice disorder. Patients with lesions in the membranous
portion of the vocal folds and voice disorders caused by gastro-
esophageal reflux showed a higher number of VTD symptoms,
particularly in comparison with disorders of neurologic etiol-
ogy. The results of these few studies indicate that the impor-
tance of pain and particularly discomfort may have been
underestimated in the voice clinic.
Hitherto, all studies were conducted in a Britain, Polish,
or Brazilian population, and little information is yet available
on the prevalence of VTD in a nonclinical population.
Anke Luyten, et al Vocal Tract Discomfort in the Flemish Population 309

Nevertheless, mapping the prevalence of VTD in a nonclinical
population in relation to vocal load activities would provide a
framework to which the symptoms of VTD in patients with
voice disorders could be weighted. Moreover, the consistency
between the VTD scale and other questionnaires frequently
used in diagnosing voice problems is still uncertain. Therefore,
the main aim of the present study was to assess the presence of
VTD in the Flemish population without self-perceived voice
disorders. The relationship with activities that demand heavy
vocal use and/or vocal abuse will be verified. In addition, the
consistency between the VTD scale and the VHI and the
Corporal Pain scale will be evaluated.
MATERIALS AND METHODS
The present study was approved by the Ethics Committee of the
Ghent University Hospital, Belgium (EC2013/1067). All sub-
jects signed an informed consent before participation.
Participants
Students of the Speech-Language Therapy education of the
Ghent University, Belgium, recruited 333 participants without
self-perceived voice problems by convenience sampling be-
tween October 2013 and September 2014. Friends, family,
and acquaintances were contacted either face-to-face or by
phone or e-mail to ask if they wanted to participate. In addition,
snowball sampling was used to raise the number of participants.
No material incentive for participation was offered.
The sample consisted of 207 women (62%) and 126 men
(38%) with a mean age of 30 years (range, 18–81 years). An equal
number of students (n ¼ 170) and employees/job seekers/
pensioners (n ¼ 163) were included. Students were particularly
recruited at the Ghent University, whereas employees/job
seekers/pensioners were sought in the researchers’ circle of
acquaintances. Within this last category, 14% (47/333) were
professional voice users. Overall, 8% (28/333) of the participants
were smokers, 16% (54/333) reported to shout frequently, 23%
(78/333) had at least one allergy, and 3% (11/333) received
voice therapy. An overview of the participants’ details and their
exposure to vocal risk factors is presented in Table 1.
Methods
The participants were asked to complete the Dutch translation
of the VTD scale5 to assess the prevalence of VTD symptoms
in the current Flemish sample (Appendix 1). This scale con-
sisted of eight symptoms or sensations that can be felt in the
throat (ie, burning, tight, dry, aching, tickling, sore, irritable,
and lump in the throat). For all items, the participants were
asked to indicate the frequency (never, seldom, sometimes,
more than sometimes, often, very often, always) and severity

TABLE 1.
Overview of the Participants’ Details and Their Exposure to Vocal Risk Factors
Employees, Job Seekers,
Parameters Students Pensioners All
n 170 (51%) 163 (49%) 333 (100%)
Mean age (range) 21 y (18–28 y) 46 y (21–81 y) 30 y (18–81 y)
Gender 122 \, 48 _ 85 \, 78 _ 207 \, 126 _
Study 44 (26%) Speech-Language Therapy Not applicable Not applicable
4 (2%) Teacher
19 (11%) Physical Therapy
15 (9%) Psychology
13 (8%) Communication Sciences
12 (7%) Chemistry
5 (3%) Law
58 (34%) Other
Vocal load 43 (25%) member of youth movement 47 (14%) professional Not applicable
38 (22%) team sport voice users
35 (21%) member of student’s union 185 (56%) nonprofessional
13 (8%) music school voice users
101 (30%) missing
Smoking 9 (5%) yes 19 (12%) yes 28 (8%) yes
92 (54%) no 144 (88%) no 236 (71%) no
69 (41%) missing 69 (21%) missing
Shouting 24 (14%) frequently 30 (18%) frequently 54 (16%) frequently
77 (45%) not frequently 133 (82%) not frequently 210 (63%) not frequently
69 (41%) missing 69 (21%) missing
Allergy 36 (21%) yes 42 (26%) yes 78 (23%) yes
65 (38%) no 121 (74%) no 186 (56%) no
69 (41%) missing 69 (21%) missing
Voice therapy 3 (2%) yes 8 (5%) yes 11 (3%) yes
88 (52%) no 149 (91%) no 237 (71%) no
79 (46%) missing 6 (4%) missing 85 (26%) missing
310 Journal of Voice, Vol. 30, No. 3, 2016

(no, almost no, limited, more than limited, moderate, more than
moderate, severe perception) on a seven-point Likert scale. The
instructions were provided in written.
In addition, the participants completed the standardized
Dutch translation of the VHI,4 which assesses the psychosocial
influence of voice disorders on the quality of life, and the
Corporal Pain scale,9 which is used to study the presence of
corporal pain symptoms. The VHI consisted of 30 questions,
which cover emotional (n ¼ 10), physical (n ¼ 10), and func-
tional (n ¼ 10) aspects of the voice. The questions were rated ac-
cording to a five-point ordinal scale (never, almost never,
sometimes, almost always, always). The total score ranged
from 0 (no problem perceived) to 120 (severely disabled). The
Corporal Pain scale asked for the symptoms of 12 corporal pains
of two categories: proximal corporal pain located next to the lar-
ynx, neck, and shoulder girdle (ie, temporomandibular joint/
mandible pain, tongue pain, sore throat, shoulder pain, neck
pain, and diffuse pain) and distal corporal pain located in other
regions of the body (ie, headache, back pain, chest pain, arm
pain, hand pain, and earache). For each corporal pain, the fre-
quency (never, sometimes, often, almost always, always) and in-
tensity (score on 10) needed to be indicated. The questionnaires
were provided to the participants via e-mail or in paper.
Statistical analysis
Statistical analysis was performed using SPSS software
(Version 22, IBM Corp, Armonk, NY) with significance levels
set at a ¼ 0.05. Descriptive statistical analysis assessed the
occurrence frequency of categorical variables as well as the me-
dian and range for continuous variables. Nonparametric Mann-
Whitney U tests were performed for between–subject group
comparisons of ordinal variables. Moreover, nonparametric
Spearman rank correlation coefficients were calculated to
assess the consistency between the VTD scale (ordinal vari-
ables), the VHI (continuous variable), and the Corporal Pain
scale (ordinal variables). In addition, Mann-Whitney U tests
were used to compare the frequency and severity of VTD symp-
toms of participants with a total VHI score above and below the
cutoff score of 20.
RESULTS
Prevalence of Vocal Tract Discomfort
Table 2 presents the prevalence of symptoms of VTD reported
by the Flemish participants. Overall, the participants reported a
median number of three symptoms of VTD (range 0–8), and
88% (292/333) of all participants mentioned at least one symp-
tom. When the frequency ‘‘seldom’’ was not taken into account,
a median number of one symptom of VTD (range 0–8) was ob-
tained, and 71% (237/333) of all participants mentioned at least
one VTD symptom. Dryness, lump in the throat, and tickling
were the most frequently occurring symptoms, whereas aching
and soreness were hardly reported with a frequency more than
seldom. When symptoms of VTD occurred, most rated the
severity between ‘‘almost no perception’’ and ‘‘more than
limited perception.’’
Influencing variables. Within the Flemish participants, the
frequency (P ¼ 0.001) and severity (P ¼ 0.001) of the symptom
tightness were significantly higher for women compared with
those for men. Students reported a significantly higher fre-
quency and more severe perceptions of the symptoms dryness
(F: P ¼ 0.049, S: P ¼ 0.003), tickling (F: P ¼ 0.033, S:
P ¼ 0.004), and lump in the throat (F: P ¼ 0.003, S:
P ¼ 0.008) compared with employees/job seekers/pensioners.
Within this group of students, participants with a voice-related

TABLE 2.
Results on the Vocal Tract Discomfort Scale Expressed in Percent
n ¼ 333 Burning Tight Dry Aching Tickling Sore Irritable Lump
Frequency
Never 68% (228) 67% (222) 30% (101) 83% (277) 38% (126) 88% (294) 65% (215) 46% (154)
Seldom 14% (47) 13% (42) 25% (84) 11% (35) 25% (85) 7% (23) 17% (57) 13% (44)
Sometimes 14% (45) 14% (45) 26% (86) 4% (13) 22% (74) 2% (8) 11% (35) 22% (72)
More than sometimes 3% (9) 5% (17) 14% (46) 2% (5) 10% (33) 2% (5) 5% (17) 10% (32)
Often 1% (4) 2% (5) 4% (13) 1% (3) 5% (15) 1% (3) 2% (8) 8% (25)
Very often 0% (0) 0% (1) 1% (2) 0% (0) 0% (0) 0% (0) 0% (1) 2% (6)
Always 0% (0) 0% (1) 0% (1) 0% (0) 0% (0) 0% (0) 0% (0) 0% (0)
Severity
No perception 69% (228) 67% (222) 30% (101) 84% (279) 37% (124) 89% (295) 65% (216) 46% (153)
Almost no perception 8% (26) 11% (35) 19% (64) 7% (24) 21% (71) 5% (15) 12% (39) 12% (39)
Limited perception 11% (38) 13% (43) 23% (76) 5% (16) 20% (65) 2% (8) 12% (39) 17% (57)
More than limited 7% (22) 7% (23) 18% (58) 3% (10) 13% (44) 2% (8) 6% (21) 13% (44)
perception
Moderate perception 5% (15) 2% (8) 8% (25) 1% (3) 8% (25) 1% (3) 3% (11) 8% (26)
More than moderate 1% (3) 0% (1) 1% (4) 0% (1) 1% (3) 1% (4) 2% (7) 4% (12)
perception
Severe perception 0% (1) 0% (1) 1% (4) 0% (0) 0% (1) 0% (0) 0% (0) 1% (2)
Note: The exact count is presented between brackets.
Anke Luyten, et al Vocal Tract Discomfort in the Flemish Population 311

Correlations between the VTD scale and the VHI and

TABLE 3.
Results on the Voice Handicap Index (VHI)
Parameters Median Minimum Maximum
Functional score (on 40) 2 0 14
Emotional score (on 40) 0 0 19
Physical score (on 40) 2 0 21
Total score (on 120) 6 0 50
study (ie, study for a profession that involves heavy vocal use,
here speech-language therapist and teacher) showed signifi-
cantly more complaints of soreness (P ¼ 0.039) and irritation
(P ¼ 0.036) as well as significantly higher severity scores for
tightness (P ¼ 0.044), soreness (P ¼ 0.031), and irritation
(P ¼ 0.025) compared with students with a non–voice-related
study. Moreover, playing a team sport and being a member of
a youth movement, both hobbies associated with heavy vocal
use and/or vocal abuse, was related with higher frequency and
severity scores for, respectively, irritation (F: P ¼ 0.012, S:
P ¼ 0.010), and tickling (F: P ¼ 0.023, S: P ¼ 0.012), soreness
(F: P ¼ 0.010, S: P ¼ 0.009) and irritation (F: P ¼ 0.009, S:
P ¼ 0.004). Being a member of a student union or going to a mu-
sic school had no significant influence on the VTD (P > 0.05).
Furthermore, no significant differences (P > 0.05) in VTD
were noted between professional and nonprofessional voice
users, smokers and nonsmokers, or participants with and
without an allergy. However, participants who reported to shout
frequently showed significantly higher frequency and severity
scores for all symptoms of VTD (P < 0.05), except for soreness.
Finally, participants who received voice therapy reported signif-
icantly more frequently the symptoms tightness (P ¼ 0.019),
dryness (P ¼ 0.034), and aching (P ¼ 0.001) and had a signifi-
cantly more severe perception of aching (P < 0.01).
corporal pain scale
The participants’ scores on the VHI and the Corporal Pain scale
are provided in Tables 3 and 4, respectively. The median total
VHI score was 6 (range, 0–50). Ninety percent (298/333)
obtained a total VHI score of 20, indicating absence of a
disability, whereas 10% (32/333) and 1% (3/333) presented with
a mild (score 21–40) and moderate (score 41–60) disability,
respectively. Furthermore, a median number of one type of
corporal pain was reported by the participants (range, 0–11).
The most frequently occurring type was sore throat (64%, 212/
332), followed by headache (29%, 96/332) and neck pain (23%,
78/332). For all types of corporal pain, a median intensity score
of 0 was obtained, except for sore throat (median 2).
The Spearman rank correlations, calculated for the frequency
and severity of all items of the VTD scale and the total VHI
score, were all positive and significant (P < 0.001; Table 5).
However, the correlation coefficients (r) were low, as they var-
ied between 0.232 and 0.411 for frequency and between 0.226
and 0.388 for severity. Comparison of patients with a total VHI
score above and below the cutoff score of 20 revealed that all
symptoms of VTD were significantly more frequent and more
severe reported by the first group (P < 0.001 or P ¼ 0.001).
Regarding the frequency (r ¼ 0.020–0.374) and severity/inten-
sity (r ¼ 0.016–0.408) of VTD sensations and corporal pain
symptoms, low to very low positive correlation coefficients
were obtained (Table 6).
DISCUSSION
In addition to specific vocal complaints such as hoarseness,
VTD symptoms are often reported by voice patients in clinical
practice. Although these symptoms are not directly treated by
the voice therapist,6 previous studies have demonstrated that
traditional voice therapy7 and laryngeal manual therapy5 might

TABLE 4.
Results on the Corporal Pain Scale
Frequency Intensity (Score on 10)

n ¼ 333 Never Sometimes Often Almost Always Always Median Minimum Maximum
Headache 71% (237) 25% (83) 3% (11) 1% (2) 0% (0) 0 0 9
TMJ/mandible pain 88% (292) 12% (39) 1% (2) 0% (0) 0% (0) 0 0 6
Tongue pain 96% (320) 4% (12) 0% (1) 0% (0) 0% (0) 0 0 6
Sore throat 36% (121) 55% (183) 8% (26) 1% (3) 0% (0) 2 0 8
Neck pain 77% (255) 18% (59) 4% (12) 2% (7) 0% (0) 0 0 9
Shoulder pain 82% (273) 14% (46) 3% (11) 1% (3) 0% (0) 0 0 9
Back pain 80% (267) 13% (45) 5% (15) 1% (4) 1% (2) 0 0 9
Diffused pain 95% (316) 4% (12) 1% (4) 0% (0) 0% (1) 0 0 7
Earache 91% (303) 7% (23) 2% (6) 0% (1) 0% (0) 0 0 8
Hand pain 97% (323) 3% (9) 0% (1) 0% (0) 0% (0) 0 0 6
Chest pain 94% (313) 6% (19) 0% (1) 0% (0) 0% (0) 0 0 8
Arm pain 96% (319) 3% (10) 1% (2) 0% (0) 1% (2) 0 0 8
Note: The frequency is expressed in percent with the exact count presented between brackets. Moreover, the median and minimum and maximum intensity
scores are provided.
Abbreviation: TMJ, temporomandibular joint.
312
TABLE 5.
Spearman Rank Correlations Between the Frequency and Severity of VTD Symptoms and the Total VHI Score
Parameters Burning Tight Dry
Frequency
Total VHI r ¼ 0.365 r ¼ 0.344 r ¼ 0.403 r ¼ 0.325
P < 0.001 P < 0.001 P < 0.001 P < 0.001
Severity
Total VHI r ¼ 0.353 r ¼ 0.338 r ¼ 0.363 r ¼ 0.322
P < 0.001 P < 0.001 P < 0.001 P < 0.001
additionally lead to a decrease in VTD symptoms. Little infor-
mation is, however, yet available about the distribution of VTD
symptoms in the general population. Nevertheless, this would
be valuable to have a framework to which results of patients
with voice disorders can be weighted. Therefore, the main
aim of the present study was to assess the prevalence of VTD
in the Flemish population without self-perceived voice disor-
ders and to examine the relationship between vocal load and
VTD.
A relatively high number of participants reported symptoms
of VTD, although the frequency and severity of these symptoms
were rather low. Eighty-eight percent of the participants
reported at least one VTD symptom, and a median of three
symptoms per participants was noted. This finding was compa-
rable with the mean number of symptoms (ie, 2.8) reported by
Rodrigues et al6 for teachers without vocal complaints, indi-
cating that a few low-frequency/severity sensations of VTD
are not necessarily related to the voice disorder in patients
consulting a voice clinic. As expected, the mean number of
symptoms reported in studies that assessed VTD symptoms in
a clinical population was higher. Lopes et al,8 for example,
reported a mean of 4.01 symptoms in patients with various types
of voice disorders who did not receive voice therapy. Moreover,
a mean number of 6.3 symptoms was reported for teachers with
nontreated self-reported voice problems by Rodrigues et al.6
In the Flemish sample, dryness (70%), tickling (62%), and
lump in the throat (54%) were the most frequently reported
VTD symptoms. Similarly, Woznicka et al7 reported the highest
median frequency scores (ie, 4, ‘‘often’’) for dry, tickling, and
lump in the throat in teachers with occupational dysphonia
before speech therapy. However, although aching (17%) and
soreness (22%) were rarely mentioned by the Flemish partici-
pants in the present study, Lopes et al8 described aching
(71%) and sore throat (59%) to be part of the most frequently
reported VTD symptoms of patients with various voice disor-
ders. Consequently, it is still unclear whether the distribution
of voice symptoms (independent of the magnitude) is similar
for the nonclinical and clinical population. Further research in
this field is required.
Overall, the frequency and severity of VTD symptoms,
particularly irritation and soreness, seemed to be related to
the participants’ vocal load. Shouting frequently, participating
in a youth movement, performing a voice-related study, and
playing a team sport seemed to be significant influencing fac-
tors, which is in line with the general consensus that increased
Journal of Voice, Vol. 30, No. 3, 2016
Aching Tickling Sore Irritable Lump
r ¼ 0.278 r ¼ 0.232 r ¼ 0.367 r ¼ 0.411
P < 0.001 P < 0.001 P < 0.001 P < 0.001
r ¼ 0.277 r ¼ 0.226 r ¼ 0.383 r ¼ 0.388
P < 0.001 P < 0.001 P < 0.001 P < 0.001
vocal load might induce voice disorders.10 Remarkably, no
significant differences in frequency or severity of VTD symp-
toms were observed between professional and nonprofessional
voice users or between smokers and nonsmokers. However,
previous studies observed an increased prevalence of voice
disorders in professional voice users such as teachers11 as
well as in smokers.12 The current finding might be explained
by the relatively low number of professional voice users and
smokers included in this study. Further research with equal
groups of (non)professional and (non)smokers seems to be
necessary to draw reliable conclusions. Moreover, it would
be interesting to explore the prevalence and severity of VTD
in behavioral dysphonia as compared with organic voice
problems.
An additional aim of the present study was to assess the con-
sistency between the VTD scale and other related question-
naires such as the VHI4 and the Corporal Pain scale.9 Low
correlations were obtained between the frequency and severity
of the VTD scale on the one hand and the total VHI score
(r ¼ 0.226–r ¼ 0.411) and the frequency and intensity of the
Corporal Pain scale (r ¼ 0.016–r ¼ 0.408) on the other hand.
Nevertheless, all correlations with the total VHI score and
most correlations with the Corporal Pain scale were significant.
Similarly, Woznicka et al7 obtained a significant low positive
correlation between the total VHI score and the VTD frequency
(r ¼ 0.466) and severity (r ¼ 0.477) after voice therapy. Before
voice therapy, the nonsignificant correlation coefficients were
even lower (r ¼ 0.221 and r ¼ 0.178). Thus, although the three
questionnaires seem to be significantly related, they seem to use
somehow different perspectives to assess a vocal problem.
Additional valuable clinically important information about
one’s sensations in the head and neck region can be obtained
with the VTD scale. No other instrument completely deals
with this type of information. Therefore, it can be considered
to use this scale in consultations of voice patients in addition
to the VHI.
The main limitation of the present study involves a relatively
high number of missing values about the presence or absence of
vocal load (ie, smoking, shouting, allergy, voice therapy, (non)
professional voice user), which might have affected the results.
Moreover, the amount of vocal abuse during activities which
require heavy vocal use was not questioned. Therefore, it was
not possible to reveal a causal relationship between vocal
load and VTD. In addition, clinical examination of voice disor-
ders using videolaryngostroboscopic assessment as well as
Anke Luyten, et al Vocal Tract Discomfort in the Flemish Population 313

TABLE 6.
Spearman Rank Correlations Between the Frequency and Severity of VTD Symptoms and Frequency and Severity of the
Corporal Pain Symptoms
Subtest Parameters Burning Tight Dry Aching Tickling Sore Irritable Lump
Frequency
Frequency Headache r ¼ 0.229 r ¼ 0.129 r ¼ 0.237 r ¼ 0.198 r ¼ 0.200 r ¼ 0.164 r ¼ 0.204
P < 0.001 P ¼ 0.019 P < 0.001 P < 0.001 P < 0.001 P ¼ 0.003 P < 0.001
TMJ* r ¼ 0.160 r ¼ 0.135 r ¼ 0.136
P ¼ 0.003 P ¼ 0.014 P ¼ 0.013
Tongue r ¼ 0.116 r ¼ 0.184 r ¼ 0.147 r ¼ 0.109
P ¼ 0.035 P ¼ 0.001 P ¼ 0.007 P ¼ 0.047
Throat r ¼ 0.335 r ¼ 0.275 r ¼ 0.374 r ¼ 0.254 r ¼ 0.319 r ¼ 0.187 r ¼ 0.348 r ¼ 0.263
P < 0.001 P < 0.001 P < 0.001 P < 0.001 P < 0.001 P ¼ 0.001 P < 0.001 P < 0.001
Neck r ¼ 0.125 r ¼ 0.140 r ¼ 0.165 r ¼ 0.156
P ¼ 0.023 P ¼ 0.010 P ¼ 0.003 P ¼ 0.004
Shoulder r ¼ 0.141 r ¼ 0.119 r ¼ 0.152
P ¼ 0.010 P ¼ 0.030 P ¼ 0.005
Back r ¼ 0.136 r ¼ 0.138 r ¼ 0.131 r ¼ 0.174 r ¼ 0.147 r ¼ 0.132
P ¼ 0.013 P ¼ 0.011 P ¼ 0.017 P ¼ 0.001 P ¼ 0.007 P ¼ 0.016
Diffused r ¼ 0.125 r ¼ 0.141 r ¼ 0.163 r ¼ 0.137 r ¼ 0.124 r ¼ 0.184 r ¼ 0.139
P ¼ 0.023 P ¼ 0.010 P ¼ 0.003 P ¼ 0.013 P ¼ 0.023 P ¼ 0.001 P ¼ 0.011
Earache r ¼ 0.130 r ¼ 0.128 r ¼ 0.153 r ¼ 0.142 r ¼ 0.147 r ¼ 0.169 r ¼ 0.164
P ¼ 0.017 P ¼ 0.019 P ¼ 0.005 P ¼ 0.010 P ¼ 0.007 P ¼ 0.002 P ¼ 0.003
Hand r ¼ 0.161 r ¼ 0.153
P ¼ 0.003 P ¼ 0.005
Chest r ¼ 0.111 r ¼ 0.164 r ¼ 0.185 r ¼ 0.191 r ¼ 0.109
P ¼ 0.043 P ¼ 0.003 P ¼ 0.001 P < 0.001 P ¼ 0.048
Arm r ¼ 0.120 r ¼ 0.138 r ¼ 0.151 r ¼ 0.178 r ¼ 0.131
P ¼ 0.028 P ¼ 0.012 P ¼ 0.006 P ¼ 0.001 P ¼ 0.017
Severity
Intensity Headache r ¼ 0.228 r ¼ 0.111 r ¼ 0.189 r ¼ 0.168 r ¼ 0.162 r ¼ 0.141 r ¼ 0.232
P < 0.001 P ¼ 0.043 P ¼ 0.001 P ¼ 0.002 P ¼ 0.003 P ¼ 0.010 P < 0.001
TMJ* r ¼ 0.167 r ¼ 0.128 r ¼ 0.139
P ¼ 0.002 P ¼ 0.020 P ¼ 0.011
Tongue r ¼ 0.137 r ¼ 0.185 r ¼ 0.165 r ¼ 0.128
P ¼ 0.012 P ¼ 0.001 P ¼ 0.003 P ¼ 0.019
Throat r ¼ 0.366 r ¼ 0.270 r ¼ 0.408 r ¼ 0.314 r ¼ 0.285 r ¼ 0.253 r ¼ 0.365 r ¼ 0.267
P < 0.001 P < 0.001 P < 0.001 P < 0.001 P < 0.001 P < 0.001 P < 0.001 P < 0.001
Neck r ¼ 0.118
P ¼ 0.032
Shoulder r ¼ 0.148 r ¼ 0.136 r ¼ 0.110
P ¼ 0.007 P ¼ 0.013 P ¼ 0.045
Back r ¼ 0.110 r ¼ 0.133 r ¼ 0.148 r ¼ 0.108
P ¼ 0.045 P ¼ 0.016 P ¼ 0.007 P ¼ 0.049
Diffused r ¼ 0.136 r ¼ 0.123 r ¼ 0.110 r ¼ 0.154 r ¼ 0.185 r ¼ 0.149
P ¼ 0.013 P ¼ 0.025 P ¼ 0.045 P ¼ 0.005 P ¼ 0.001 P ¼ 0.006
Earache r ¼ 0.155 r ¼ 0.133 r ¼ 0.192 r ¼ 0.123 r ¼ 0.140 r ¼ 0.180 r ¼ 0.181 r ¼ 0.162
P ¼ 0.005 P ¼ 0.015 P < 0.001 P ¼ 0.024 P ¼ 0.011 P ¼ 0.001 P ¼ 0.001 P ¼ 0.003
Hand r ¼ 0.108 r ¼ 0.210 r ¼ 0.123
P ¼ 0.049 P < 0.001 P ¼ 0.025
Chest r ¼ 0.109 r ¼ 0.112 r ¼ 0.184 r ¼ 0.204
P ¼ 0.047 P ¼ 0.041 P ¼ 0.001 P < 0.001
Arm r ¼ 0.112 r ¼ 0.178 r ¼ 0.180 r ¼ 0.135
P ¼ 0.041 P ¼ 0.001 P ¼ 0.001 P ¼ 0.013
Note: Only the significant correlations (P < 0.05) are presented.
Abbreviation: TMJ, temporomandibular joint.
314 Journal of Voice, Vol. 30, No. 3, 2016

perceptual and objective assessment of voice quality was not APPENDIX 1

included in the present study, although it would have been use-
ful to determine the absence of voice disorders more accurately. Dutch translation of Vocal Tract Discomfort scale
Finally, the current Flemish sample was relatively young (mean
age 30 years). Considering the high prevalence of voice disor- Gelieve bij elk van de onderstaande gewaarwordingen aan te
ders in the elderly population,13 further research should focus geven hoe frequent deze ervaring voorkomt en in welke mate
on the prevalence of VTD symptoms in older people. u deze ervaart. Hieronder vindt u enige uitleg over de door
ons gebruikte begrippen.
CONCLUSIONS Branderig: gloeiend en ontstoken
In conclusion, a relatively high prevalence of VTD symptoms is Geknepen: spanning ter hoogte van de keel
present in the Flemish population, although the occurrence fre- Droog: schurend
quency and severity are overall rather low. Vocal load seems to Zeurende pijn: continue, doffe, oppervlakkige pijn
influence the frequency and severity of VTD. Considering that Kriebelend: tintelend gevoel dat niet overgaat bij het stemg-
the VTD scale showed low correlations with the VHI and even of hoesten
Corporal Pain scale, the VTD scale might reveal valuable extra Stekende pijn: plots opkomende pijn bij het stemgeven of bij
information when used during voice consultations in addition to het aanraken van de keel
the VHI. Ge€ırriteerd: prikkelend, warm
Globusgevoel: gevoel van een ‘‘brok in de keel’’ waardoor
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