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Original Investigation
April 30, 2020

Chronic Pain Syndromes and Their Laryngeal Manifestations

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
  • 2Division of ENT Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
JAMA Otolaryngol Head Neck Surg. 2020;146(6):543-549. doi:10.1001/jamaoto.2020.0530
Key Points

Question  What is the prevalence of different voice and laryngeal disorders in patients with chronic pain syndromes (CPSs) such as fibromyalgia syndrome, irritable bowel syndrome, and chronic fatigue syndrome?

Findings  In this case series of 4249 patients, 215 with CPS and 4034 without CPS, patients with CPS were more likely to present with functional voice disorders, such as muscle tension dysphonia, and were less likely to present with laryngeal or airway problems.

Meaning  The clinical manifestations of the 3 types of CPS evaluated in this study, fibromyalgia syndrome, irritable bowel syndrome, and chronic fatigue syndrome, appear to be indistinguishable from each other in their voice and airway presentation, which suggests that these disorders may be different clinical manifestations of a shared pathophysiology.


Importance  Fibromyalgia syndrome (FMS), irritable bowel syndrome (IBS), and chronic fatigue syndrome (CFS) are traditionally considered as distinct entities grouped under chronic pain syndrome (CPS) of an unknown origin. However, these 3 disorders may exist on a spectrum with a shared pathophysiology.

Objective  To investigate whether the clinical presentation of FMS, IBS, and CFS is similar in a population presenting with voice and laryngeal disorders.

Design, Setting, and Participants  This case series was a retrospective review of the medical records and clinical notes of patients treated between January 1, 2016, and December 31, 2017, at the Johns Hopkins Voice Center in Baltimore, Maryland. Patients with at least 1 CPS of interest (FMS, IBS, or CFS) were included (n = 215), along with patients without such diagnoses (n = 4034). Diagnoses, demographic, and comorbidity data were reviewed. Diagnoses related to voice and laryngeal disorders were subdivided into 5 main categories (laryngeal pathology, functional voice disorders, airway problems, swallowing problems, and other diagnoses).

Main Outcomes and Measures  Prevalence and odds ratios of 45 voice and laryngeal disorders were reviewed. Odds ratios (ORs) were calculated by comparing patients with CPS with control patients.

Results  In total, 4249 individuals were identified; 215 (5.1%) had at least 1 CPS and 4034 (94.9%) were control participants. Patients with CPS were 3 times more likely to be women compared with the control group (173 of 215 [80.5%] vs 2318 of 4034 [57.5%]; OR, 3.156; 95% CI, 2.392-4.296), and the CPS group had a mean (SD) age of 57.80 (15.30) years compared with the mean (SD) age of 55.77 (16.97) years for the control group. Patients with CPS were more likely to present with functional voice disorders (OR, 1.812; 95% CI, 1.396-2.353) and less likely to present with laryngeal pathology (OR, 0.774; 95% CI, 0.610-0.982) or airway problems (OR, 0.474; 95% CI, 0.285-0.789).

Conclusions and Relevance  The voice and airway presentation of patients with FMS, IBS, and/or CFS appears to be indistinguishable from each other. This finding suggests that these 3 diseases share upper airway symptoms.

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