# Introduction ormal voice is a key factor to maintain the standard quality of life. Dysphonia makes the patient isolated, which may induce his stress, anxiety, and depression [1]. There are four causes of dysphonia: 1. Inflammatory. 2. Structural or Neoplastic. 3. Neuromuscular. 4. Muscle tension dysphonia [2]. The assessment of singers, teachers, and other professional voice users, an understanding of their Occupational and voice requirements is essential [3] [4] [5]. Chronic laryngitis occurs due to upper and lowers respiratory tract infection gave the decision by Steel and McLoughlin in 1976 in their research paper [6]. Chronic laryngitis is directly related to occupations like excess noise at work [7], asbestos workers [8], cement workers [9], solvents and shoe workers [10]. The allergy is related to chronic laryngitis, which directly affects larynx and lung [11]. Gastro-esophageal (GERD) and laryngopharyngeal reflux (LPR) is one of the debating etiological factors of chronic laryngitis [12]. Candidal infection causes chronic laryngitis, usually seen in patients of post-irradiated, immune-compromise state, diabetes mellitus, after prolonged antibiotic administration [13]. Smoking is the key factor of chronic laryngitis [14]. MTD has multiple primary causes, includes 1. Stress, anxiety and depression. 2. Conversion disorder. 3. Poor vocal hygiene [15]. Laryngeal carcinoma is one of the commonest sites of malignancy which mainly affect men cause dysphonia [16]. A true vocal cord polyp arises from the free edge of vocal cord which size is greater than 03 mm [17]. Vocal cord nodules are small bilateral swelling less than 03 mm size, produce dysphonia and occur in student, teacher, singer, and leader [18]. Vocal cord paralysis is another prime cause of dysphonia, which may be iatrogenic and idiopathic, may be unilateral or bilateral [19]. Reinke's edema is chronically and irreversibly, polypoidal swelling of vocal cords, also known as smoker's larynx [20]. Leukoplakia, TB laryngitis, papilloma, ulcer, and cyst are minor causes of dysphonia. # II. # Methods and Materials The study performed in two tertiary care hospitals. During the three years period, 116128 patients attended in the outpatient department of the Government Comilla Medical College Hospital, and 33840 in the Private Comilla Medical Centre, concern Clinic of Central Medical College, Comilla. Out of 149968, the laryngeal disarrayed patient was 1739. Firstly, the dysphonic patient consulted with the village doctor (Health Assistant) in the shop of the drug, and Community Health Worker (Government) working in the primary care preventive non-bedded hospital. Secondly, they consulted with the Graduate Doctor who works in the secondary care hospital named 50 bedded Upazilla Health Complex. The patient came to the tertiary care hospital after suffering from dysphonia from one month to one year. We performed the endoscopic assessment of all patients with rigid Hopkin's telescope (RTL). Some patient examined by traditional I/L and FOL. The patient and attended if the patient is children gave written informed consent about the examination procedure. The following information collected about the patient: Gender, age, personal history, occupation, residence, predisposing factor, presenting feature, investigation, disease pattern, and treatment option. Descriptive statistics used to calculate the data. # Results The incidence among outpatient was 1.16%, and the yearly prevalence of 33.33%. Among them, the male was 1006 (57.85%), and the female was 733 (42.15%) Figure- We also calculate the distribution of dysphonic disorders according to sex. Table - IV. # Discussion In the present study, non-specific chronic laryngitis was the most common disease-producing dysphonia 1015 (58.37%) kept up by Khammas AH, Abodamen, and Kataria et al. series, reported the highest occurrence of chronic laryngitis accordingly 19.11%, 27.91% and 20.55% [22] [23] [24]. The patient was mostly male, 57.14 %, also supported by Goswami S et al. showed 62% patient was male [25]. About predisposing factors, allergic manifestation was the second most causes in our results 2.01% held up by Hamdan AL et al. also reported 15-25% singers to have dysphonia with allergic rhinitis [26]. Reflux originated Distribution of laryngeal pathology due to symptoms of dysphonia among our patient was seventeen hundreds thirty nine. Incidence of dysphonia was 1.16% among outpatient department and the yearly prevalence of 33.33 % in our study consistent with Roy et al. series, showed 30% prevalence rate [21]. Epidemiological Aspects of Dysphonia in Tertiary Care Hospital chronic laryngitis was 2.53% in our study against Jacob et al. showed 25% patient of chronic laryngitis was associated with reflux-related [27]. # Medical Research The second most common cause of dysphonia was functional or MTD in our work. Out of 417 (23.98%) MTD patients, the male was 238 (57.07%), and the female 179 (42.93%), opposite to Altman KW et al. series, they observed 60% were female and 40% male [15]. Personal history revealed in our work, previous radiotherapy was 19 (1.09%) and radioiodine ablation 13(0.75%) who suffered from anxiety, tension and mood disorder always about their future handicap supported by House A. et al. study showed one-third of functional dysphonic patients abide by anxiety and mood disorder [28]. The third most common cause malignant lesion was 5.17% in our paper persistent with Khammas AH and Kataria et al. study, reported third common cause was malignancy accordingly 16.9% and 11.67% [22] [24]. Kiakojoury K et al. also supported our research, showed laryngeal cancer caused dysphonia was 2.5% [29]. Smoking is the prime risk factor of our study 52.39%, supported by all other studies like Goswami S and Khammas AH et al. reported accordingly 100% and 53.68% [25] [22]. Vocal cord polyp was 3.79% dysphonia in our series against Goswami S et al. paper, showed 16.9% case [25]. Sex distribution in our study the male was 57.58%, and the female was 42.42% near to Singh R et al. research revealed male, the female ratio was 2:1 [30]. Vocal cord nodule was 55 (3.16%) in the present study isn't compatible with Babu VS et al. series, showed vocal nodule 11.95% [31]. The female was 72.73%, and the male 27.27% kept up by Goswami S et al. reported 67.86% was female, and 32.14% was male [25]. Vocal cord paralysis was 35 (2.01%) in our research consistent with Roy D et al. work, Presented a 2.9% case was paralysis [32]. Gender distribution displayed the female was 20 (58.82%), and the male 14 (41.18%)-, due to female thyroidectomy was 08 times more than male in our hospitals held up by Ko HC et al. series [33]. In our paper, 26 (1.49%) was a fungal infection in which the female was 21 (80.77%) and the male 05 (19.25%). It is associated with an immuno-compromised patients like post-irradiated, radioiodine ablation, frequently received antibiotics. In our work postirradiated 19 (1.09%) and radioiodine ablation 13 (0.75%) supported by Vrabec DP's study [13]. Reinke's edema was in our work 21 (1.27%) held up by Singh R et al. reported 2% whereas Goswami S et al. against our study showed 26.7% [30] [25]. Smoking (52.39%) was the main risk factor for Reinke's edema in our research kept up by Ballenger JJ. series [34]. Vocal cord leukoplakia is the premalignant condition. Among 04 (0.23%), the male was 03(75%), and the female 01 (25%) in this work. The risk factor for it in our report was smoking (52.39%) and voice abuse (26.97%) kept up by Sing R et al. series [30]. Laryngeal TB is secondary to pulmonary TB. Smoking (52.39%) is another risk factor held up by Chopra H et al. paper [35], reported 03 (4.48%) patients of laryngeal TB. In our study, only 02 (0.12%) cases of adult papilloma whereas Goswami S showed JRRP patient was 11 (1.4%) [25]. The ulcer may be a premalignant condition or due to TB and Syphilis supported by Bhat VK et al. series [36]. Cyst of the epiglottis is a rare condition. Only one female patient found epiglottis cyst which was mucous retention cyst [2] V. # Conclusion Dysphonia is one of the prime symptoms of the laryngeal disorder. The rigid RTL is available for accurate and safe examination, and assessment of the disease condition. Proper treatment and management can be reduced the morbidity and mortality rate of the patient suffering from various laryngeal diseases that causes dysphonia. ![Figures and tables citeted by Microsoft word 2007. III.](image-2.png "") ![1, patient wasn't found between 0-9 years, 10-19 years were 191 (10.98%), 20-29 years 208 (11.96%), 30-39 years 226 (13%), 40-49 years 278 (15.99%), 50-59 years 488 (28.06%), 60-69 years 226 (13%), and above 70 years 122 (7%), whereas mean age 44.34 and the standard deviation 17.247 Figure-1.](image-3.png "") ![Figure-1: Age, Sex and Occupation.](image-4.png "") 23![Figure-2: Personal history, predisposing factor, residence and well known presenting feature.](image-5.png "Figure- 2 :Figure- 3 :") 56![Figure-5: Supraglottic huge growth.](image-6.png "Figure- 5 :Figure- 6 :") 7![Figure-7: Vocal cord nodule.](image-7.png "Figure- 7 :") 8![Figure-8: Functional dysphonia.](image-8.png "Figure- 8 :") ![](image-9.png "") -0 200 400 600 800 1000 1200 1400 1600 1800Serial Number 1 2 3Laryngeal Disorders Non-specific chronic laryngitis Dysphonia without structural change/Functional/MTD Malignant growthPatient in Govt. hospital 420 230 69Patient in Private hospital 595 187 21Total patient 1015 417 90Percentage 58.37% 23.98% 5.17%Volume XX Issue VIII Version I4 5Vocal cord polyp Vocal cord nodule61 3805 1766 553.79% 3.16%D D D D )6Vocal cord paralysis3401352.01%(7 8 9 10 11 12 13Candidiasis Reinke's edema Vocal cord leukoplakia Laryngeal TB Vocal cord Papilloma Vocal cord ulcer Cyst on epiglottis09 21 03 03 02 02 0117 01 01 01 00 00 0026 22 04 04 02 02 011.49% 1.27% 0.23% 0.23% 0.12% 0.12% 0.06%Medical ResearchT0tal8938461739100%Table-2: Distribution of laryngeal disorders according to sex.SerialLaryngeal disordersMalePercentageFemalePercentage1Chronic laryngitis (1015)58057.14%43542.86%2Functional/MTD (417)23857.07%17942.93%3Malignancy (90)8897.78%022.22%4Vocal cord polyp (66)3857.58%2842.42%5Vocal nodule (55)1527.27%4072.73%6Vocal paralysis (35)1440%2160%7Candidiasis (26)0519.23%2180.77%8Reinke's edema (22)1881.82%0418.18%9Leukoplakia (04)0375%0125%10TB laryngitis0375%0125%11Vocal Papilloma (02)02100%0000%12Vocal Ulcer (02)02100%0000%13Cyst (01)0000%01100%Total1739100657.85%73342.15% -SerialNo. of patientLaryngeal disordersSmokingVoice abuserAlcoholBetel leafAllergic disorderReflux related11015Chronic laryngitis494302001902009002417Functional2521020032121900390Malignancy88000002000000466Vocal polyp30180010000800555Vocal nodule10350500000500635Vocal paralysis10000500000020726Candidiasis00050015030300822Reinke's edema17040100000000904Leukoplakia030100000000001004TB Laryngitis030100000000001102Papilloma020000000000001202Ulcer020000000000001301cyst00010000000000Total173991146911249354420100%52.39%26.97%0.63%14.32%2.01%2.53%1.15%Figure-4: Normal Larynx. © 2020 Global JournalsEpidemiological Aspects of Dysphonia in Tertiary Care Hospital ## Ethical Approval The Institutional Review Committee approved the study, headed by the Principal of the Medical College, chief editor of the Journal of comilla medical college teachers association is secretary and all head of the department was member named Journal Review Ethics Committee. ## Funding: None Competing Interest: The authors declared that they have no competing interest. * The Prevalence of major psychiatric pathologies in patients with voice disorders NMirza CRuiz EDBaum JPStaab Ear Nose Throat J 82 2003 * Structural disorders of the vocal cords YGKaragama JAMcglashan Scott-Brown's * Otorhinolaryngology Head & Neck Surgery, volume-3, section-1 2019 943 Eighth edition * Description of Patients consulting the voice clinic regarding gender, age, occupational status, and diagnosis ARemacle CPetitfils CFinck DMorsome Eur Arch Otorhinolaryngol 274 3 2017 * Prevalence of voice disorders in singers: Systemic review and meta-analysis PMPestana SVaz-Freitas MCManso J voice 31 6 2017 * Study of risk factor for development of school teachers in Mangalore, India AAlva MMachado KBhojwani SSreedharan J Clin Diagn Res 11 1 2017 * The aetiology of chronic laryngitis PMStell MPMcloughlin Clin Otolaryngol Allied Sci 1 3 1976 * Vocal cord dysfunction: an industrial health hazards ERontel MRonfal HJJacob MIRolnick Ann Otol Rhno Laryngol 88 1979 part-1 * Effect of asbestos dust on the upper respiratory tract MTaniewski WRene MGraczyk Bull Inst Marit Trop Med Gdynia 30 2 1979 * Changes in workers of a cement factory WSulkowski SKowalska JIzycki IGielec * Otolaryngol Polska 34 4 63 1980 * Chronic rhinitis/laryngitis WedTurner NZ Med J 170 1999 * Aiiergies and vocal fold edema: a preliminary report JacksonMelandi CADzul AIHolland RW J Voice 13 1 1999 * Chronic Laryngitis associated with gastro esophageal reflux: Perspective assessment of difference in practice patterns between gastroenterologist and ENT physicians TFAlmed FKhandwala TIAbelson Am J Gastroentrol 101 3 2006 * Fungal infection of the larynx DPVravec Otolaryngol Clin North Am 26 6 1993 * Chronic Laryngitis. Scott-Brown's Otorhinolaryngology Head & Neck Surgery KMackenzie 2019 1012 Eighth edi * Current and emerging concepts in muscle tension dysphonia: 30 month review KWAltman CArkinson CLazarus J Voice 19 2 2005 * GLOBOCAN 2012 vI.o. Cancer incidence and mortality worldwide: IARC Cancer Base No.-11 JFerlay ISoerjomataram MErvic International Agency for Research on Cancer 2013. 2013 * A comparative histopathological study of vocal fold polyp in smokers versus nonsmokers KGEffat MMilad J Laryngol Otol 129 5 2015 * Vocal fold nodule vs Vocal fold polyp: answer from surgical pathologist point of view LWallis CAJacson-Menaldi WHolland GiraldoA J Voice 18 2004 * Vocal cord paralysis (VCP)-An etiologic review of 100 cases over 20 years JHKeasley Aust NZ J Med 11 1981 * The protective role of autophagy in human vocal fold fibroblasts under cigarette smoke extract exposure: a new insight into the study of Reinke's edema JWong RFang APeterson JJJiang Otorhinolaryngology 78 1 2016 * Voice disorders in the general population: Prevalence, risk factors, and occupational impact NRoy RMMerrill SDGray EMSmith Laryngoscope 115 2005 * Evaluation of chronic hoarseness presentation time in patients with different laryngeal pathologies AHKhammas IMAl-Shareda MRDawood Otorhinolaryngologia 67 4 2017 * Causes of hoarseness in Benin City POAdobamen Nigeria. J Otol Rhinol 4 2015 * Hoarseness of voice. Etiological Spectrum GKataria ASaxena BSingh SBahget RSingh Online J Otologic 1 2015 * A Clinicopathological study of Hoarseness of voice SGoswami SKesarwaani KDBasumata Sch J APP. Med. Sci. Apr 6 4 2018 * The use of screening questionnaire to determine the incidence of allergic rhinitis in singers with dysphonia ALHamdan ASibal MYoussef RDeeb FZeitoun Arch Otolaryngol Head Neck Surg 132 2006 * Proximal esophageal P H -metry in patients with 'reflux laryngitis PJacob PJKahritas GHerzon Gastroenterology 100 1991 * The psychiatric and social characteristics of patient with functional dysphonia AHouse HAndrews J Psychosomatic Res 31 1987 * Etiologies of Dysphonia in patients Referred to ENT clinics Base on Videolaryngoscopy KKiakojoury MDehghan FHajizade SKhafri Iran J Otorhinolaryngol 26 76 2014 Jul * A Clinicopathological Study of Patient's with organic Dysphonia RSingh SPrinja J. of Contemporary Medical Research 3 9 September 2016 * Hoarseness of voice: a retrospective study of 251 cases VSBabu SShaik Indian J Appl Res 6 2016 * The Evaluation of hoarseness and its treatment DRoy NMoran IOSR. Journal of Dental and Medical Sciences 16 8 2017 * Etiologic factors in patients with unilateral vocal cord paralysis in Taiwan HCKo LALee HYLi TJFang Chang Gung Med J 32 2009 * Disease of the nose, throat, ear, head and neck JJBallenger 1991 Lee & Febiger * Study of benign glottis lesion underlying microlaryngeal surgery HChopra MKapoor Indian J Otolaryngol Head Neck Surg 49 3 1997 Jul * Clinical pathological review of tubercular laryngitis in 32 cases of pulmonary Kocks VKBhat PLatha DUpadhya Am J Otolaryngol 30 5 2009