Hoarseness, Quality of Life, and Social Anxiety: A Case-Control Study

Abstract

Hoarseness is a common voice symptom that can impair communication and lead to psychosocial difficulties. It has been hypothesized that chronic hoarseness may contribute to elevated social anxiety. This study aimed to assess the impact of hoarseness on quality of life and social anxiety in affected individuals. Thirty-eight patients with chronic hoarseness (voice disorders) and 40 matched healthy controls were evaluated in a prospective case-control study. Quality of life was measured using the WHOQOL-BREF questionnaire (Physical, Psychological, Social, and Environmental domains). Social anxiety was assessed with the Liebowitz Social Anxiety Scale (LSAS), and general anxiety and depression with the Hospital Anxiety and Depression Scale (HADS). Group scores were compared using appropriate statistical tests, and effect sizes with 95% confidence intervals were calculated. Patients with hoarseness had significantly lower Psychological Health and Social Relationships scores on the WHOQOL-BREF than controls (p < 0.01 for both; large effect sizes), indicating worse quality of life in these domains. Physical Health and Environmental domain scores did not differ between groups. The hoarseness group also showed higher social anxiety: LSAS total scores and Social Interaction subscale scores were significantly greater than those of controls (p < 0.01 and p < 0.05, respectively; moderate-to-large effects), whereas the Performance Anxiety subscale was similar between groups. By contrast, HADS anxiety and depression scores did not differ significantly between patients and controls. Notably, mean HADS scores in both groups fell in the mild (borderline) range rather than the normal range. Chronic hoarseness is associated with reduced quality of life in emotional and social domains and with increased social anxiety symptoms, but not with elevated general anxiety or depression. These findings underscore the need to address psychosocial factors, particularly social anxiety, in the clinical management of patients with voice disorders.