{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:04:45Z","timestamp":1789535085465,"version":"build-2803163510"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"\n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n This systematic review and meta-analysis followed PRISMA 2020. PubMed, Embase, Scopus, Web of Science,\n ClinicalTrials.gov<\/jats:ext-link>\n 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\u2013Knapp 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.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n 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\u201337.5%; five datasets;\n n<\/jats:italic>\n = 1,613,921; I\n 2<\/jats:sup>\n = 99.8%; 95% prediction interval 0.001\u201399.1%). Prevalence was 40.0% in high-vocal-demand personnel (95% CI 0.8\u201398.2%; three datasets;\n n<\/jats:italic>\n = 3,708; I\n 2<\/jats:sup>\n = 99.5%; prediction interval 0\u2013100%) and 72.8% in chemically exposed cohorts (95% CI 43.3\u201390.4%; three datasets;\n n<\/jats:italic>\n = 145; I\n 2<\/jats:sup>\n = 57.5%; prediction interval 0.6\u201399.9%). An exploratory meta-regression identified an overall subgroup association (\n p<\/jats:italic>\n = 0.0300), but pairwise findings were inconsistent and statistical power was limited. Certainty of evidence was Very Low for all three estimates.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Systematic review registration<\/jats:title>\n \n PROSPERO\n https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420250640753<\/jats:ext-link>\n , identifier: CRD420250640753.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1942500","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T04:33:39Z","timestamp":1789533219000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence of voice disorders in military personnel: a systematic review and meta-analysis"],"prefix":"10.3389","volume":"14","author":[{"given":"Joanna","family":"Morawska","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz","place":["\u0141\u00f3d\u017a, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Polita\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Electromagnetic Hazards, Nofer Institute of Occupational Medicine","place":["\u0141\u00f3d\u017a, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiktoria","family":"Nowak","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz","place":["\u0141\u00f3d\u017a, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamila","family":"Przegali\u0144ska","sequence":"additional","affiliation":[{"name":"Information and Library Center, Medical University of Lodz","place":["\u0141\u00f3d\u017a, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karolina","family":"M\u0119drala","sequence":"additional","affiliation":[{"name":"Information and Library Center, Medical University of Lodz","place":["\u0141\u00f3d\u017a, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wioletta","family":"Pietruszewska","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz","place":["\u0141\u00f3d\u017a, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"B1","unstructured":"Washington, DC\n Department of the Army\n Army Regulation 600-100: Army Profession and Leadership Policy\n \n 2024"},{"key":"B2","doi-asserted-by":"publisher","first-page":"3364","DOI":"10.1044\/2023_JSLHR-23-00150","article-title":"Prevalence of self-reported voice concerns and associated risk markers in a nonclinical sample of military service members","volume":"66","author":"Perry","year":"2023","journal-title":"J Speech Lang Hear Res."},{"key":"B3","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1016\/j.jvoice.2021.05.013","article-title":"Characterization of vocal fold pathology in military drill instructors","volume":"37","author":"Duvall","year":"2023","journal-title":"J Voice."},{"key":"B4","doi-asserted-by":"publisher","first-page":"694","DOI":"10.1016\/j.jvoice.2019.02.015","article-title":"Prevalence, characteristics and impact of dysphonia in us marine corps drill instructors","volume":"34","author":"Spellman","year":"2020","journal-title":"J Voice."},{"key":"B5","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1288\/00005537-199009000-00013","article-title":"Symptoms of vocal attrition in women army instructors and new recruits: Results from a survey","volume":"100","author":"Sapir","year":"1990","journal-title":"Laryngoscope."},{"key":"B6","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1159\/000021519","article-title":"Voice problems at work: a challenge for occupational safety and health arrangement","volume":"52","author":"Vilkman","year":"2000","journal-title":"Folia Phoniatrica et Logopaedica."},{"key":"B7","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1159\/000078344","article-title":"Occupational safety and health aspects of voice and speech professions","volume":"56","author":"Vilkman","year":"2004","journal-title":"Folia Phoniatrica et Logopaedica."},{"key":"B8","doi-asserted-by":"publisher","first-page":"116","DOI":"10.3934\/medsci.2021012","article-title":"How does noise pollution exposure affect vocal behavior? 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