Mursalin M. Anis

Objective To determine the association of social determinants of health (SDOH) on the presentation and management of unilateral vocal fold immobility (UVFI). Methods Retrospective chart review of 207 adult UVFI patients evaluated at a tertiary‐care hospital between 2018 and 2019 was performed. Sociodemographic factors including gender, median household income, preferred language, and insurance type were recorded. Confounding clinical factors including etiology of UVFI, Voice Handicap Index‐10 (VHI‐10) score, laryngoscopic findings, and intervention history were extracted from medical records. Multivariable logistic regression was performed using sociodemographic and clinical factors. Results Patient demographics and socioeconomic status were not associated with time to presentation. Patients presenting with glottic insufficiency and UVFI due to malignancy or recurrent laryngeal nerve (RLN) sacrifice had a shorter time to presentation. Higher household income was associated with greater number of interventions ( p = 0.02), but neither income nor insurance type affected intervention type or timing. Female patients were less likely to undergo injection medialization laryngoplasty (odds ratio [OR] 0.25, p = 0.005). Older patients were more likely to undergo injection (OR 1.04, p = 0.027). Patients with large glottic gaps (OR 21.2, p = 0.014) and higher VHI‐10 scores (OR 1.06, p = 0.047) were more likely to undergo surgery. Conclusion Higher household income was associated with greater number of interventions and longer duration of care at a private tertiary‐care hospital. RLN sacrifice, known malignancy, and glottic insufficiency significantly reduced the time to presentation. Type of intervention received was a complex interplay of both demographic and clinical factors. Large prospective studies should examine the role of SDOH in the presentation and management of UVFI. Level of Evidence 4 Laryngoscope , 134:297–304, 2024

Objective This study aimed to compare the prevalence and incidence of vocal fold pathologies among undergraduate classical, musical theatre, and contemporary commercial music (CCM) students over two‐time points. Methods This study is part of a longitudinal investigation. Videostroboscopic examinations were rated, with consensus among three of four expert blinded raters confirming the presence of pathology. Association between genre of singer and the presence of pathology, interrater reliability, and intra‐rater reliability were calculated. Prevalence and incidence of pathologies were compared across genres. Results During first‐year evaluations, 32% of musical theatre, 18% of CCM, and 0% of classical students had vocal pathologies. The prevalence at third‐year evaluations showed 22% of classical, 39% of musical theatre, and 27% of CCM participants having vocal fold pathologies. The incidence of pathologies was 67% of musical theatre students compared to 22% of classical students and 27% of CCM students. The four raters demonstrated fair to moderate interrater agreement. Singing Voice Handicap Index‐10 scores were normal for CCM singers at both time points but elevated for musical theatre and classical singers. Conclusion No classical singers were found to have pathology during first‐year evaluations, although CCM and musical theatre singers showed evidence of vocal fold pathologies. At third‐year evaluations, all three genres had an apparent increase in prevalence of pathologies. Implications of this study suggest that more time in the field and intense voice usage may lead to a greater risk of pathology for all singers, regardless of genre. Level of Evidence 2 Laryngoscope , 133:2317–2324, 2023