Voice Disorder in Cystic Fibrosis Patients

Abstract

Cystic fibrosis is a common autosomal recessive disorder with drastic respiratory symptoms, including shortness of breath and chronic cough. While most of cystic fibrosis treatment is dedicated to mitigating the effects of respiratory dysfunction, the potential effects of this disease on vocal parameters have not been systematically studied. We hypothesized that cystic fibrosis patients, given their characteristic respiratory disorders, would also present dysphonic symptoms. Given that voice disorders can severely impair quality of life, the identification of a potential cystic fibrosis-related dysphonia could be of great value for the clinical evaluation and treatment of this disease. We tested our hypothesis by measuring vocal parameters, using both objective physical measures and the GRBAS subjective evaluation method, in male and female cystic fibrosis patients undergoing conventional treatment and compared them to age and sex matched controls. We found that cystic fibrosis patients had a significantly lower vocal intensity and harmonic to noise ratio, as well as increased levels of jitter and shimmer. In addition, cystic fibrosis patients also showed higher scores of roughness, breathiness and asthenia, as well as a significantly altered general grade of dysphonia. When we segregated the results according to sex, we observed that, as a group, only female cystic fibrosis patients had significantly lower values of harmonic to noise ratio and an abnormal general grade of dysphonia in relation to matched controls, suggesting that cystic fibrosis exerts a more pronounced effect on vocal parameters of women in relation to men. Overall, the dysphonic characteristics of CF patients can be explained by dysfunctions in vocal fold movement and partial upper airway obstruction, potentially caused by the accumulation of mucus and chronic cough characteristic of CF symptomatology. Our results show that CF patients exhibit significant dysphonia and suggest they may potentially benefit from voice therapy as a parallel treatment strategy.

Prevalence and Severity of Dysphonia in Patients with Cystic Fibrosis

“…Other limitations include lack of laryngoscopy and pulmonary function data, which we would like to include in future studies. Although decreased expiratory force and undiagnosed vocal fold pathologies in patients with CF could potentially contribute to objective worsening of voice parameters, Lourençxo et al 6 did not observe significant differences in laryngoscopy findings between their CF and control groups. Assessment of cough severity, which could also influence voice outcomes, would be useful.…”

Voice disorder in systemic lupus erythematosus

“…Vocal recordings and spectrograms of representative individuals are shown in Fig 1 . Recordings from control subjects ( Fig 1A1 and 1B1 ) showed standard features of euphonic voice, including low waveform variability and high periodic amplitude modulation, as well as spectrograms ( Fig 1C1 ) with well-defined formant frequencies and low noise [ 6 , 19 ]. In contrast, vocal signals from SLE subjects showed reduced amplitude and high variability ( Fig 2A2 and 2B2 ), in addition to spectrograms with high noise and dampened formant frequencies ( Fig 1C2 ).…”

“…Vocal recordings and analyses were performed as described in a previous study from our group [ 6 ]. In brief, subjects were requested to produce a sustained /a/ vowel phonation in their usual intensity for a maximum voicing time, which was recorded using a hand-held microphone (PG42-LC, Shure) positioned six centimeters from the subject’s mouth at a 45° angle.…”

“…Five objective parameters of voice quality were measured: fundamental frequency (F 0 ), intensity, jitter (index of F 0 variability), shimmer (index of intensity variability) and the harmonics to noise ratio (HNR; index of glottal turbulence noise and hoarseness). These measurements are considered direct physical measures of vocal quality: low values of vocal intensity and HNR, high values of jitter and shimmer and altered F 0 are considered potential signs of dysphonia [ 6 , 15 ]. Qualitative vocal parameters were assessed using the GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) scale, an extensively validated instrument for perceptual voice quality evaluation [ 16 – 18 ].…”

“…Consequences of voice disorders include increased risk of depression and anxiety disorders, increase in stress as well as reduced self-reported measures of health [ 3 – 5 ]. Interestingly, dysphonia can be associated with some chronic diseases, including cystic fibrosis and Parkinson’s disease, contributing to the burden on patient wellbeing [ 6 – 8 ].…”