Prevalence of voice disorders in military personnel: a systematic review and meta-analysis.
Voice and related laryngeal disorders may affect communication, occupational functioning and readiness in military populations, but their prevalence remains poorly characterized. We estimated prevalence across general military populations, high-vocal-demand personnel and chemically exposed military or veteran cohorts.
This systematic review and meta-analysis followed PRISMA 2020. PubMed, Embase, Scopus, Web of Science, ClinicalTrials.gov and Google Scholar were searched in September 2024. Eligible studies included active-duty personnel, recruits, reservists or veterans and reported voice or related laryngeal outcomes. Clinically referred or symptom-selected cohorts were synthesized narratively. Subgroup-specific random-effects meta-analyses used logit-transformed proportions, restricted maximum likelihood estimation and Hartung-Knapp adjustment. Prediction intervals and generalized linear mixed-model sensitivity analyses were calculated. Risk of bias and certainty of evidence were assessed using design-appropriate appraisal tools and GRADE.
Sixteen studies were included in the systematic review, and 11 independent datasets from nine studies contributed to the meta-analysis. In general military populations, pooled prevalence was 3.3% (95% CI 0.2-37.5%; five datasets; n = 1,613,921; I2 = 99.8%; 95% prediction interval 0.001-99.1%). Prevalence was 40.0% in high-vocal-demand personnel (95% CI 0.8-98.2%; three datasets; n = 3,708; I2 = 99.5%; prediction interval 0-100%) and 72.8% in chemically exposed cohorts (95% CI 43.3-90.4%; three datasets; n = 145; I2 = 57.5%; prediction interval 0.6-99.9%). An exploratory meta-regression identified an overall subgroup association (p = 0.0300), but pairwise findings were inconsistent and statistical power was limited. Certainty of evidence was Very Low for all three estimates.
Reported prevalence varies substantially across military populations and exposure contexts. Because heterogeneity was high and the certainty of evidence was Very Low, the pooled estimates should be interpreted with caution and should not be considered precise prevalence figures or evidence of causation. Standardized prospective studies are needed to quantify the occupational-health burden and evaluate targeted surveillance, prevention and early-referral approaches.
PROSPERO https://www.crd.york.ac.uk/PROSPERO/view/CRD420250640753, identifier: CRD420250640753.
This systematic review and meta-analysis followed PRISMA 2020. PubMed, Embase, Scopus, Web of Science, ClinicalTrials.gov and Google Scholar were searched in September 2024. Eligible studies included active-duty personnel, recruits, reservists or veterans and reported voice or related laryngeal outcomes. Clinically referred or symptom-selected cohorts were synthesized narratively. Subgroup-specific random-effects meta-analyses used logit-transformed proportions, restricted maximum likelihood estimation and Hartung-Knapp adjustment. Prediction intervals and generalized linear mixed-model sensitivity analyses were calculated. Risk of bias and certainty of evidence were assessed using design-appropriate appraisal tools and GRADE.
Sixteen studies were included in the systematic review, and 11 independent datasets from nine studies contributed to the meta-analysis. In general military populations, pooled prevalence was 3.3% (95% CI 0.2-37.5%; five datasets; n = 1,613,921; I2 = 99.8%; 95% prediction interval 0.001-99.1%). Prevalence was 40.0% in high-vocal-demand personnel (95% CI 0.8-98.2%; three datasets; n = 3,708; I2 = 99.5%; prediction interval 0-100%) and 72.8% in chemically exposed cohorts (95% CI 43.3-90.4%; three datasets; n = 145; I2 = 57.5%; prediction interval 0.6-99.9%). An exploratory meta-regression identified an overall subgroup association (p = 0.0300), but pairwise findings were inconsistent and statistical power was limited. Certainty of evidence was Very Low for all three estimates.
Reported prevalence varies substantially across military populations and exposure contexts. Because heterogeneity was high and the certainty of evidence was Very Low, the pooled estimates should be interpreted with caution and should not be considered precise prevalence figures or evidence of causation. Standardized prospective studies are needed to quantify the occupational-health burden and evaluate targeted surveillance, prevention and early-referral approaches.
PROSPERO https://www.crd.york.ac.uk/PROSPERO/view/CRD420250640753, identifier: CRD420250640753.
Authors
Morawska Morawska, PolitaĆski PolitaĆski, Nowak Nowak, PrzegaliĆska PrzegaliĆska, MÄdrala MÄdrala, Pietruszewska Pietruszewska
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