PSYCHOLOGICAL DISTRESS AND QUALITY OF LIFE IMPAIRMENT ASSOCIATED WITH LARYNGEAL SPECIFIC HYPERVIGILANCE AND ANXIETY IN PATIENTS WITH CHRONIC LARYNGEAL SYMPTOMS

Background
Cognitive affective processes such as laryngeal hypervigilance and symptom-specific anxiety likely contribute to chronic laryngeal symptoms and impart a significant psychosocial impact. These processes are modifiable with interventions; however, research is limited on the relationship between cognitive affective processes and psychosocial impact. The aims of this study were to evaluate the relationships between laryngeal hypervigilance and symptom-specific anxiety and psychosocial distress, quality of life (QOL) impairment, and symptom burden.

Methods
This prospective, single center study enrolled adults with chronic laryngeal symptoms. Patients completed a set of validated instruments: Laryngeal Cognitive-Affective Tool (LCAT), Gastroesophageal Reflux Disease Questionnaire (GerdQ), Illness Cognition Questionnaire (ICQ), Northwestern Esophageal Quality of Life Questionnaire (NEQOL), Patient-Reported Outcomes Measurement Information System (PROMIS) for Anxiety and Depression, Voice Handicap Index (VHI), and Reflux Symptom Index (RSI). The validated 15-item LCAT measures symptom-specific anxiety and hypervigilance in patients with chronic laryngeal symptoms, where a score of ≥33 is elevated. Multivariate regression analyses evaluated the association between QOL, anxiety, and depression with elevated LHAS.

Results
204 patients were included: 143 (70%) female, mean age 54.7 (16.1) years, mean BMI 27.6 (6.7) kg/m², 137 (67%) Caucasian, and 125 (61%) with an elevated LCAT score of ≥ 33. Patients with an elevated LCAT, compared to those with normal LCAT, had significantly higher PROMIS depression [17.6 (8.2) vs. 12.9 (7.0), p<0.01], PROMIS anxiety [20.1 (7.0) vs. 13.9 (5.8), p<0.01], and ICQ helplessness [12.8 (4.4) vs. 9.2 (3.2), p<0.01] scores and significantly lower NEQOL scores [24.1 (12.9) vs. 40.9 (9.8), p<0.01] and ICQ acceptance scores [13.6 (3.2) vs. 17.1 (3.8), p<0.01] (Table). In addition, patients with an elevated LCAT score had higher symptom scores including RSI [26.3 (9.3) vs. 16.4 (8.8), p<0.01], VHI [31.3 (30.8) vs. 17.5 (20.4), p<0.01] and GerdQ [9.9 (2.7) vs. 8.3 (3.1), p<0.01]. In multivariable regression models, there remained a significant relationship between total LCAT and NEQOL (R²=0.56, p<0.01), PROMIS anxiety (R²=0.49, p<0.01), and PROMIS depression (R²=0.37, p<0.01).

Conclusions
Anxiety, depression, and quality of life impairment are independently associated with laryngeal hypervigilance and symptom-specific anxiety among patients with chronic laryngeal symptoms. Multifactorial treatment modalities including the incorporation of psychosocial intervention is needed to address the psychological and physical impairment suffered by these patients.