Abstract
Introduction
United airway disease (UAD) describes shared inflammatory processes involving the upper and lower respiratory tract, including allergic rhinitis (AR), chronic rhinosinusitis (CRS), and asthma. Although anatomically positioned between the upper and lower airway, the larynx remains relatively under-characterized within this framework. Emerging evidence suggests that allergic upper-airway inflammation may extend to the larynx and contribute to dysphonia; however, existing literature is largely retrospective, and prospective characterization of laryngeal symptoms and vocal function in UAD remains limited. This study prospectively evaluates laryngeal involvement in adults with AR and/or CRS using patient-reported symptoms, voice-related quality of life, and objective acoustic measures of vocal quality.
Methods
Adults aged 18–89 years presenting to a rhinology clinic were enrolled into AR, CRS, or combined AR+CRS groups according to clinical diagnostic criteria. Participants completed the Vocal Tract Discomfort Scale (VTDS) and Voice-Related Quality of Life (V-RQOL) questionnaire and underwent standardized voice recording. Acoustic analysis in Praat included jitter, shimmer, harmonic-to-noise ratio (HNR), and smoothed cepstral peak prominence (CPPs). Clinically significant patient-reported findings were defined as VTDS >15 and/or total V-RQOL 90; objective positivity was defined as ≥1 acoustic measure exceeding its prespecified criterion. Current analyses include 45 participants with complete patient-reported data, 48 voice samples with adequate HNR for acoustic analysis, and 42 with both.
Results
Clinically significant subjective findings were present in 60.0% (27/45) of participants, while 35.6% (16/45) met both VTDS and V-RQOL criteria. Among usable recordings, 52.1% (25/48) demonstrated ≥1 dysphonia-associated acoustic finding; CPPs was the most frequently positive individual measure (43.8%). Among participants with paired data, objective abnormalities were more frequent among those with clinically significant subjective findings than among those without (61.5%, 16/26 vs 37.5%, 6/16), although this association was not statistically significant (Fisher exact p≈0.204). VTDS differed across diagnostic groups (Kruskal-Wallis p=0.040), with greater discomfort in AR than CRS after Bonferroni correction (adjusted p=0.046). Overall acoustic positivity did not significantly differ among diagnostic groups.
Conclusion
Clinically meaningful laryngeal symptoms, voice-related impairment, and acoustic abnormalities were common in this preliminary AR/CRS cohort. Subjective and objective findings showed incomplete overlap, suggesting complementary but potentially distinct dimensions of laryngeal involvement and effects on participants’ quality of life in the social and physical domains. Exploratory differences in VTDS by diagnosis further suggest that laryngeal symptom burden may vary across UAD phenotypes. These findings support continued investigation of the larynx as an underrecognized component of UAD. Completion of comparison-group recruitment, analysis of the perceptual presence, nature, and severity of dysphonia, and analysis of sinonasal disease severity and relevant covariates will further clarify these relationships.