To explore the clinical characteristics, influencing factors, and prognosis of dysphonia in live streamers.A retrospective analysis was conducted on the basic characteristics, occupational features, voice quality assessment, stroboscopy, and prognosis of 43 live streamers who sought medical attention for dysphonia.Twenty-seven female (62.79%) and 16 male (37.21%) patients were included, with an average age of 36.81 ± 8.97 years and a median course of 6 months. All patients presented with the chief complaint of hoarseness. Triggers were phonotrauma in 35 (81.40%), unclear in 6 (13.95%), and infections in 2 (4.65%). Thirty-seven patients (86.05%) were full-time streamers. The streaming duration was 2.93 ± 2.46 years, with the daily vocal use of 4.58 ± 1.55 hours and streaming frequency of 6.35 ± 1.11 days per week. Forty-one (95.35%) required high volume, and 37 (86.05%) required rapid speech. Audio-perceptual analysis showed 1.42 ± 0.52 in G and R scales and 0.41 ± 0.37 in B scale. Objective analysis revealed increased jitter (1.96% ± 1.33%), shimmer (6.52% ± 2.29%), and reduced maximum phonation time (12.67 ± 5.93 seconds). Laryngoscopy revealed polyps in 15 patients (34.88%), Reinke's edema in 14 (32.56%), cysts in 6 (13.95%), chronic hypertrophic laryngitis in 4 (9.30%), leukoplakia in 3 (6.98%), and scarring in four patients (9.30%). Of the 14 patients who underwent surgery, 13 (92.86%) significantly improved. Among 29 conservatively managed patients, 14 (48.28%) improved, with few received vocal training and education.Long-term, high-frequency, high-volume, and fast-paced vocal use may contribute to dysphonia in live streamers. Benign proliferative lesions are common voice disorders in the current treatment-seeking population. Surgery may improve voice quality, but its recurrence rate is unclear. Proper vocal training and education are crucial for live streamers and may enhance their prognosis.Copyright © 2025 The Voice Foundation. Published by Elsevier Inc. All rights reserved.