Cannabis Inhalation and Voice Disorders

Abstract

Widespread legalization of cannabis throughout the United States has created a knowledge gap that leaves practitioners who manage voice disorders uninformed about this substance, commonly referred to as marijuana. The association of cannabis inhalation and voice disorders is rarely reported. However, studies on the association between cannabis inhalation and respiration have been published; therefore, these studies may serve as a surrogate for studies on the association between cannabis and phonation.OBJECTIVE To review the literature on the association of cannabis-only consumption via smoking and vaping with the health and function of the vocal mechanism to aid clinical recommendations for patients with voice disorders.EVIDENCE REVIEW This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. An electronic search in MEDLINE via PubMed, CINAHL, Scopus, and Cochrane Library databases for original research on inhaled cannabis was performed from January 1, 2007, through August 10, 2018. The search strategy included Medical Subject Heading terms and keywords marijuana, cannabis, respiratory, lungs, larynx, voice, phonation, and vocal with Boolean operators (AND, OR). Studies of participants of legal age (Ն18 years) who had cannabis-only clinical data and used nonsynthetic cannabinoids were included in the review. FINDINGS This systematic review identified 6 clinical science studies and 13 basic science or animal studies. The only study to date that has evaluated the association between laryngeal symptoms and inhaling cannabis found that human smokers assessed by indirect laryngoscopy with mirror examination exhibited dark vocal folds. Analyses of 6 other clinical science articles indicated an association between cannabis inhalation and respiratory problems that were reduced with smoking cessation or switching to vaporizing. Lung function was maintained in light cannabis smoke exposure after long-term use. Analyses of basic science and animal articles indicated that cannabis smoking was associated with lung and throat injuries attributable to smoking degradation by-products, similar to injuries seen in human tobacco smoking. CONCLUSIONS AND RELEVANCEThe findings suggest that cannabis-only smoking is associated with changes in vocal fold appearance, respiratory symptoms, and negative lung function changes, especially in heavy smokers. Details about patterns of cannabis consumption appear to be relevant to gather in patients with voice disorders. Results further suggest that cannabis smokers presenting with a voice disorder should undergo laryngeal imaging and complete pulmonary function testing when indicated and receive education about consumption methods and their association with voice disorders.

Cannabis related side effects in otolaryngology: a scoping review

“…A small number of recent systematic reviews have studied cannabis in subspecialties within Otolaryngology, such as laryngology and H&N oncology. Meehan-Atrash et al in [ 4 ], assessed the association between inhaled cannabis and voice disorders. Similar to our review, the group only identified a single clinical study specific to voice.…”

“…Hashish is manufactured from the resin or secreted gum of the plant. Hash oil is the most potent and manufactured from the thick oil obtained from hashish [ 4 ]. There are three routes of delivery of this drug: oral, dermal, and inhaled.…”

“…There are three routes of delivery of this drug: oral, dermal, and inhaled. Smoking the drug via the inhaled route is the most popular due to the quick onset of action [ 4 ].…”

“…Chronic usage may result in periodontal disease, voice changes, impaired regulation of cell cycle, apoptosis, and cellular migration, potentially increasing the risk of head and neck malignancy [ 9 ]. Prior reviews have investigated cannabis use concerning Otolaryngology, but have been limited to the oncology and laryngology literature [ 4 , 10 ]. The purpose of this scoping review wass to understand the safety profile of cannabis and how drug use in adults has the potential for unintended side effects related to otolaryngology pathologies.…”

VpALI—Vaping-related Acute Lung Injury: A New Killer Around the Block

“…Exposure to cannabis inhalation has a negative effect on different cellular immune mechanisms, 50,51 increasing predisposition for respiratory tract infections 52 including pulmonary aspergillosis in the susceptible population [53][54][55] and also enhances eosinophilic recruitment 56 with concomitant reports of eosinophilic pneumonia after recreational marijuana exposure. 57 Cannabis consumption has been associated with voice disorders, 58 pulmonary barotrauma, 59,60 cystic lung disease, 61,62 and emphysema in the young population. 63 Moreover, chronic use has a 2-fold increase in the risk of lung cancer.…”