Vocal tract symptoms: Severity and frequency in patients on statins.

The objective of the study was to analyze the frequency and severity of vocal tract symptoms in patients on statins. A total of 73 patients were enrolled in this study, 44 patients who were taking statins and 29 controls not taking statins. The severity and frequency of vocal tract discomfort was assessed using the Vocal Tract Discomfort scale. The most frequent vocal tract symptom in patients on statins was dryness followed by tightness and lump sensation. The difference in the mean of the total score and in the mean frequency of any vocal tract symptom was not significant between patients taking statins and controls. The most severe (highest mean values) vocal tract symptom in patients taking statins also was dryness followed by tightness and lump sensation. The difference in the mean of the total score and in the mean severity of any vocal tract symptom between patients taking statins and controls was not significant. This study failed to demonstrate a higher prevalence or severity of vocal tract symptoms in patients receiving statins. Despite the lack of a significant difference in the means of vocal tract discomfort symptom frequency and severity, this study carries clinical significance when considering that a higher prevalence and severity of vocal tract discomfort symptoms should alert physicians to the possible development of statin-induced myotoxicity in the laryngopharyngeal complex.

Effect of Hormonal Replacement Therapy on Voice.

OBJECTIVE: This study aimed to investigate the effect of hormonal therapy (HRT) on voice in a group of menopausal women, taking into consideration body mass index (BMI) as a confounding factor and its potential role as a substitute for HRT. SUBJECTS AND METHODS: A total of 53 menopausal women, 34 not on HRT and 19 on HRT, were recruited. Demographic variables included age, gender, smoking, and BMI. All subjects were asked about the presence or absence of the following symptoms: hoarseness, deepening of the voice, pitch breaks, throat clearing, dryness in the throat, and vocal fatigue. Acoustic analysis was performed, and Voice Handicap Index-10 was also completed. RESULTS: The mean BMI was 25.90 ± 5.39 and 25.77 ± 4.26 in patients on HRT and not on HRT, respectively. There was no statistical difference in the Voice Handicap Index-10 score and the prevalence of any of the phonatory symptoms in menopausal women not on HRT compared with menopausal women on HRT. However, menopausal women not on HRT had significantly lower habitual pitch than those on HRT (P value of 0.022). On the other hand, the jitter was significantly higher in those on HRT (P value of 0.033). CONCLUSION: Hormonal therapy has an impact on the habitual pith in menopausal women with comparable BMI. Those on HRT have a higher habitual pitch than those not on HRT.

Clinical application of nasometry in patients with nasal obstruction.

The purpose of this case-control study is to report on the clinical application of nasometry as a diagnostic tool in patients with the symptom of nasal obstruction compared with subjects with no history of nasal obstruction. Thirty-eight adult patients (mean age: 28.1 years) complaining of nasal obstruction were enrolled in the study, and another group of 38 adults (mean age: 25.9 years) with no history of nasal obstruction served as controls. Demographic data, including age and sex, were collected. Patients were asked to read three passages; the Zoo passage, the Rainbow passage, and nasal sentences. Nasalance scores were reported on all subjects using a Nasometer II instrument. The control and patient groups each included 22 men and 16 women. No statistically significant difference in nasalance score was found between the study group and the control group in any of the Zoo passage, Rainbow passage and nasal sentences. We conclude that nasometry has limited value in the objective assessment of nasal obstruction as a symptom, which we attribute to nasal obstruction's not always reflecting the volume and pressure in the nasal cavity.

Vocal Symptoms and Acoustic Findings in Menopausal Women in Comparison to Pre-menopause Women with Body Mass Index as a Confounding Variable.

OBJECTIVES: To compare the prevalence of phonatory symptoms in menopausal women compared to pre-menopause women with body mass index (BMI) as a confounding variable. METHODS: A total of 69 women, 34 menopausal and 35 pre-menopausal were invited to participate in this study. Demographic variables included age, smoking, and BMI. All subjects were asked about the presence hoarseness, loss of high or low frequencies, pitch breaks, throat clearing, dryness in the throat and vocal fatigue. Acoustic analysis was performed and the Voice Handicap Index (VHI)-10 was filled by all the subjects. RESULTS: There was a significantly higher prevalence of throat clearing and dryness in the menopausal group compared to the pre-menopause group with a P value of 0.035 and 0.032 respectively. When BMI was taken into account, there was no statistically significant difference in the prevalence of any of the phonatory symptoms in menopausal women with high BMI and pre-menopause. There was no statistically significant difference in the means of any of the acoustic parameters between the menopausal group and pre-menopausal group. There was no significant difference in the mean VHI-10 between the menopause group and the pre-menopause (P = 0.652). CONCLUSIONS: The results of this investigation substantiate the importance of fat as an alternative source of estrogen which can mask some of the phonatory symptoms.

Effect of Vitamin D Deficiency on Voice.

PURPOSE: The purpose of this article was to investigate the relationship between low level of vitamin D, phonatory symptoms, and acoustic findings. METHOD: A total of 38 subjects presenting to the endocrinology clinic were enrolled in 2 groups: 19 with vitamin D deficiency who were not on treatment, and 19 with normal vitamin D level who were on treatment. Demographic data included age, gender, and history of smoking. All patients were asked about the presence or absence of dysphonia, degree of phonatory effort, and vocal fatigue. Acoustic analysis and perceptual evaluation using the grade, roughness, breathiness, asthenia, and strain scale were performed on all subjects. RESULTS: The mean age of the total group was 47.29 ± 13.52 years. The difference in the mean and frequency of phonatory effort, vocal fatigue, and dysphonia, and in the mean of the acoustic variables, perceptual parameters, and the score of the Voice Handicap Index-10 was not statistically significant between patients with low vitamin D levels compared with controls. CONCLUSION: The results of this study revealed no significant difference in the prevalence of phonatory symptoms in patients with vitamin D deficiency compared with patients with no vitamin D deficiency. A larger study is needed to substantiate the difference in the prevalence of phonatory systems between the 2 groups.

Effect of vitamin D deficiency on the laryngo-pharyngeal tract.

OBJECTIVE: To investigate the effect of vitamin D deficiency on the laryngopharyngeal tract. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary care center. SUBJECTS AND METHODS: A total of 38 human subjects were prospectively recruited, equally divided into two groups. The Vitamin D deficiency group defined as 25-OH<25ng/dl and the control subjects with normal vitamin D level defined as 25-OH>25ng/dl. The presence and severity of vocal tract symptoms was assessed using the Vocal Tract Discomfort score. RESULTS: There was no significant difference in vocal tract discomfort score for frequency and severity between patients with Vitamin D deficiency and patients with no vitamin D deficiency (p value 0.272). However there was a significant difference in the mean frequency of burning, aching, soreness and lump sensation (p value<0.05) in patients with vitamin D deficiency compared to those with no vitamin D deficiency. There was also a significant difference in the means of vocal tract severity symptoms, namely for burning and aching between patients with vitamin D deficiency compared to patients with no vitamin D deficiency (p value<0.05). CONCLUSION: Subjects with vitamin D deficiency do not have a higher vocal tract discomfort score than subjects with no vitamin D deficiency. However the frequency and severity of certain vocal tract discomfort symptoms was higher and can be based hypothetically on the similarity in structure between the laryngopharyngeal complex and the musculoskeletal system.

Effect of renal failure on voice.

The objective of this case-control study was to assess the impact of dysphonia on quality of life and to report the perceptual and acoustic findings in patients with chronic renal failure. A total of 22 patients with chronic renal failure and 18 healthy controls were recruited. Patients were asked to complete the Voice Handicap Index (VHI)-10 to assess the impact of dysphonia on quality of life. Perceptual evaluation of patients' voice recordings using the GRBAS classification was performed. Acoustic analysis was also conducted. Fundamental frequency, habitual pitch, shimmer, relative average perturbation, harmonic-to-noise ratio, voice turbulence index, and the maximum phonation time were reported. The mean scores of the VHI-10 were within normative values, with no significant difference between groups. There was also no significant difference in any of the acoustic parameters or in the mean score of any of the perceptual parameters between patients and controls. We conclude that patients with renal failure do not have dysphonia with a significant impact on quality of life, as evident by the normative values of the VHI-10. There were neither perceptual nor acoustic differences between patients and controls.

Association Between Facial Length and Width and Fundamental Frequency.

OBJECTIVE: This study aimed to evaluate the association between facial width and length and fundamental frequency (F0) and habitual frequency. STUDY DESIGN: Prospective cross-sectional study. SUBJECTS: A total of 50 subjects (35 females;15 males) were included in this study. METHODS: Lateral and posteroanterior cephalometric measurements included: facial height (N-Me); widths of the maxilla (J-J), mandible (AG-AG), and face (Zyg-Zyg); ratios J-J to AG-AG, N-Me to Zyg-Zyg, and lower face to total face heights. All subjects underwent acoustic analysis using Visi-Pitch IV. Sample was stratified according to age and gender. RESULTS: In the total group (mean age: 14.19±6.49 years; range 6-35 years), a significantly moderate negative correlation existed between Zyg-Zyg, J-J, and AG-AG, and F0 and habitual pitch. Similarly, N-Me moderately correlated with habitual pitch. In males, there was a significant moderate negative correlation between Zyg-Zyg and J-J, and habitual pitch, and between J-J and F0 (-0.571;p=0.026). In females, a significant moderate correlation existed between Zyg-Zyg and AG-AG, and habitual pitch, and between AG-AG and F0 (-0.347;p=0.041). In the prepubertal group (n=25), a negative moderate correlation occurred between J-J and AG-AG, N-Me and habitual frequency, and between J-J and F0 (-0.407;p=0.043). In the postpubertal group, there was a significant moderate correlation only between AG-AG and F0 (-0.403;p=0.046). CONCLUSION: Facial length correlates significantly with habitual frequency, and facial width correlates significantly with both F0 and habitual pitch. A larger sample of adult subjects is needed to substantiate this conclusion.

Formants frequency and dispersion in relation to the length and projection of the upper and lower jaws.

OBJECTIVE: Investigate the association between formants frequencies and length and sagittal projection of the maxilla and mandible. STUDY DESIGN: Cross-sectional study. METHOD: A total of 47 consecutive patients were recruited. Craniofacial measures included; maxillary length (ANS-PNS), mandibular length (Co-Gn), relationship between maxilla and mandible in the sagittal plane (ANB), the sagittal projection of the maxilla (SNA), and mandible (SNB). Subjects were asked to phonate vowels /a/, /i/, /o/, and /u/. Measurements were made in real-time and formant frequencies across F1, F2, F3, and F4 were determined. RESULTS: There was a significant negative association between the length of the maxilla and F4 for all the vowels, and a significant negative association between the length of the mandible and F4 for vowels /o/ and /u/. The length of maxilla and mandible also negatively associated with F3 for vowels /a/, /i/, /o/, and vowels /i/, /o/, and /u/ respectively. For the first two formants, the negative association was less pronounced. CONCLUSION: There was a significant negative association between the formant frequencies F3, F4, and the length of the mandible and maxilla for vowels /a/, /i/, /o/, and /u/.

Correlation between the length and sagittal projection of the upper and lower jaw and the fundamental frequency.

OBJECTIVE: To report on the correlation between the length and projection of the upper and lower jaw and the fundamental frequency (F0). STUDY DESIGN: Prospective study. MATERIALS AND METHODS: A total of 45 healthy subjects were included in this study. The facial skeletal measurements included: SNA, SNB, ANB, angles that reflect the position of the maxilla and mandible in relation to the base of skull and to each others, length of mandible Co-Gn, and length of maxilla PNS-ANS. All subjects underwent acoustic analysis using VISI-PITCH IV. RESULTS: The means for F0 and habitual frequency were 220.75 + 40.01 Hz and 216.99 + 43.9 Hz, respectively. The means for SNA, SNB, and ANB were 80.753 ± 3.20, 77.409 ± 3.64, and 3.336 ± 2.57, respectively. The mean length of the mandible and maxilla were 104.28 + 7.94 and 50.29 + 3.94, respectively. In the total group, there was a moderate negative correlation between F0 and habitual frequency and the length of the mandible (r = -0.528 and -0.577, respectively). There was also a moderate negative correlation between F0 and habitual frequency and the length of the maxilla (r = -0.473 and -0.519, respectively). Similar findings were present after excluding the pubertal subjects. With respect to the other cephalometric measurements, the correlation was poor (r value < 0.3). CONCLUSIONS: There is a moderate negative correlation between the length of the upper and lower jaw and the average F0 and habitual frequency. The remaining facial sagittal projection parameters do not correlate with the average F0 and habitual frequency.

Correlation of methylenetetrahydrofolate reductase polymorphisms with homocysteine metabolism in healthy Lebanese adults.

Hyperhomocysteinemia is associated with several vascular and teratogenic conditions. Determinants of total homocysteine concentrations include genetic and nutritional factors. This study assesses the relation between homocysteine concentrations and MTHFR gene polymorphisms at two common alleles (C677T (rs1801133) and A1298C (rs1801131)) as well as other predictors of homocysteine (folate, vitamin B(12), body mass index (BMI), age, and gender) in a group of healthy Lebanese: 109 males and 124 females aged 17-55years. We used serum for the determination of homocysteine, folate and vitamin B(12) levels and blood drawn in EDTA tubes for molecular analysis of MTHFR polymorphisms. Hyperhomocysteinemia was present in 59/233 (25.3%) of the subjects, with male/female ratio of 1.95. Multivariable regression analysis showed that homocysteine levels were negatively related to folate and vitamin B(12) and positively related to male gender and C677T homozygosity; but not A1298C polymorphism, BMI or age. The prevalence of wild, heterozygous, and homozygous C677T genotypes was 45.0%, 43.3% and 11.6%, respectively; with a carrier frequency of 54.9% and allelic frequency of 33.3%. The A1298C genotypic prevalence was 39.5%, 30.9%, and 29.6% respectively; with a carrier frequency of 60.5% and allelic frequency of 45.1%. C677T/A1289C compound heterozygosity was present in 47/233 (20.2%) of volunteers. In this first pilot study, gender, folate, vitamin B(12) and C677T mutational status could explain around 32% of homocysteine variations. Future larger studies are recommended to investigate other predictors of homocysteine variation and combine them with markers explored in this and other studies, in order to evaluate their impact on vascular and/or congenital diseases.

Should we screen for hereditary hemochromatosis in healthy Lebanese: a pilot study.

Hereditary hemochromatosis (HHC) is a genetic disorder of iron metabolism characterized by abnormal accumulation of iron that may lead to organ damage and death. Diagnosis is usually based on various genetic and phenotypic criteria. The study goals were to perform mutation analysis for 18 different mutations associated with HHC in healthy Lebanese, determine their allele frequency, and compare iron-overload status in identified carriers versus those found to be wild-type for mutations analyzed. 116 healthy adults (59 males and 57 females) underwent DNA testing for 18 different HHC mutations, and biochemical testing for percent transferrin saturation (%TS) and ferritin. C282Y mutation was not detected. Only H63D mutation (rs1799945) was found with an overall carrier frequency of 25.8% (24.1% heterozygous and 1.7% homozygous). %TS and ferritin differed significantly between genders. %TS and ferritin were significantly higher in males with H63D mutation when compared to males with wild-type (P=0.001, 0.019; respectively); but not in females. The proportion of subjects with increased %TS and serum ferritin was not statistically different between those with H63D mutation and the wild-type in either gender. In addition, none of the subjects had concurrent increase in %TS and ferritin. In conclusion, the H63D carrier frequency in healthy Lebanese is comparable to other populations in the region, and it does not result in significant biochemical iron overload. Moreover, in the absence of the C282Y mutation, genetic screening for HHC is not recommended according to this preliminary study in healthy Lebanese.

The use of a reverse hybridization strip assay for the study of hemochromatosis-associated gene mutations in Lebanon.

AIMS: Hereditary hemochromatosis (HHC) is the most commonly identified autosomal recessive genetic disorder in the Caucasian population and HFE gene mutations are highly concentrated among European populations. This is the first study that screens for HHC-related gene mutations in a healthy Lebanese sample population. METHODS: Using the reverse hybridization Hemochromatosis StripAssay A from ViennaLab, the DNA extracted from a total of 116 healthy volunteers (59 males and 57 females) was analyzed, looking for 18 different mutations in the HFE, ferroportin, and transferrin genes. RESULTS: For the HFE gene, the C282Y mutation was not detected, but the H63D mutation was found with an overall carrier frequency of 25.8% (24.1% heterozygous and 1.7% homozygous). None of the mutations in the transferrin and ferroportin genes was identified. CONCLUSIONS: The Hemochromatosis StripAssay A from ViennaLab provides an easy and reliable technique for simultaneous screening of the different HFE gene mutations. This first study in Lebanon represents a baseline report for further future studies in the field using this easy technique with a reasonable turnaround time for diagnosis. We also note that ferroportin and transferrin gene mutations have not been detected in this population sample and larger clinical studies will be needed to better estimate their prevalence.

Comparison of neutrophil volume distribution width to C-reactive protein and procalcitonin as a proposed new marker of acute infection.

BACKGROUND: The aim of this study was to assess the use of neutrophil distribution width (NDW) and to compare it to C-reactive protein (CRP) and procalcitonin (PCT), in the detection of early sepsis in the intensive care unit. METHODS: Subjects (N = 166) were divided into 4 groups: healthy, acute inflammatory non-infectious (AINI), localized infection, and systemic infection, according to clinical history and cultures. NDW, CRP, and PCT were compared among the different groups using multivariate analysis of variance (MANOVA). Diagnostic efficacy was assessed using receiver operating characteristic curves and areas under the curves (AUC). RESULTS: The lowest mean(NDW) was found in the healthy group (n = 41), followed by the AINI (n = 20), localized infection (n = 55), and systemic infection (n = 50) groups. AUC(NDW) was 0.877 for infected (localized + systemic) vs non-infected (healthy + AINI) groups, and 0.965 for systemic infection vs non-infected groups. A cut-off of 21.9 resulted in 90% sensitivity, 92% specificity, 90% positive predictive value, and 92% negative predictive value (AUC(NDW) = 0.965, 95% confidence interval 0.935-0.995). According to MANOVA, only NDW was able to differentiate an acute inflammatory process from early infection in postoperative patients, but not healthy from AINI subjects. CONCLUSIONS: NDW had the highest diagnostic accuracy and is available with the complete blood count with differential (CBC). It may be a promising parameter to aid in the diagnosis of acute infection in adults, provided the possibility of haematological disorders is first ruled out.