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“The Impact of Socioeconomic Status on Voice Outcomes in Patients with Spasmodic Dysphonia Treated with Botulinum Toxin Injections” Dianne Valenzuela, Joel Singer, Terry Lee, Amanda Hu


Objectives: To determine the impact of socioeconomic status (SES) on voice outcomes for spasmodic dysphonia (SD) patients treated with botulinum toxin injections


Methods: This was a prospective cross-sectional study in a tertiary care, academic, voice clinic in Canada. Adult SD patients returning to the voice clinic for botulinum toxin injections were recruited from October 2017 to April 2018. Patients completed a questionnaire on demographic data, the Hollingshead Four-Factor Index for socioeconomic status (validated instrument based on education, occupation, gender, and marital status), and the Voice-Handicap Index 10 (VHI-10) (validated instrument on self-reported vocal handicap). Primary outcome was the association between VHI-10 and Hollingshead Index. Secondary variables were median household income by postal code, duration of disease, gender, age, and professional voice user. Descriptive statistics and multiple linear regression was conducted.


Results: One hundred and one patients (age 62.8 ± 13.7 years, 20.8% male) were recruited with VHI-10 of 22.1 ± 8.1 (out of 40) and Hollingshead Index of 46.3 ± 11.7 (range 8 to 66). Median household income was $75,875 ± $16,393, which was above the Canadian average of $70,336.  About 91.1% were Caucasian, 54.4% had university degree, 86.1% spoke English, and 43.5% were employed. In multiple linear regression, there was mild to moderate negative correlation (r=-0.292, p=0.004) between VHI-10 and Hollingshead Index when controlling for disease duration, age, gender, and professional voice use.


Conclusion: SD patients treated with botulinum toxin were mostly affluent, Caucasian, well educated, and English speakers.  Lower self-perceived vocal handicap was associated with higher socioeconomic status.

Learning Objectives

  1. To describe the association between socioeconomic status and voice outcomes of patients with spasmodic dysphonia
  2. To understand whether socioeconomic status has an impact on voice outcomes in voice disorders, particularly spasmodic dysphonia

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Scheduling Details

This 7 minute presentation is scheduled to take place on June 4, 2019 at 10:35 in the Salon 8.

Authors' Contact Details

Corresponding Author: Dr. Dianne Valenzuela

Senior Author: Dr. Amanda Hu

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