Detection of hormone receptors in the human vocal fold

Transcriptome Analysis of Left Versus Right Intrinsic Laryngeal Muscles Associated with Innervation

OBJECTIVES/HYPOTHESIS

Recurrent laryngeal nerve injury diagnosed as idiopathic or due to short-term surgery-related intubation exhibits a higher incidence of left-sided paralysis. While this is often attributed to nerve length, it is hypothesized there are asymmetric differences in the expression of genes related to neuromuscular function that may impact reinnervation and contribute to this laterality phenomenon. To test this hypothesis, this study analyzes the transcriptome profiles of the intrinsic laryngeal muscles (ILMs), comparing gene expression in the left versus right, with particular attention to genetic pathways associated with neuromuscular function.

STUDY DESIGN

Laboratory experiment.

METHODS

RNA was extracted from the left and right sides of the rat posterior cricoarytenoid (PCA), lateral thyroarytenoid (LTA), and medial thyroarytenoid (MTA), respectively. After high-throughput RNA-Sequencing, 88 samples were organized into 12 datasets according to their age (P15/adult), sex (male/female), and muscle type (PCA/LTA/MTA). A comprehensive bioinformatics analysis was conducted to compare the left-right ILMs across different conditions.

RESULTS

A total of 774 differentially expressed genes were identified across the 12 experimental groups, revealing age, sex, and muscle-specific differences between the left versus right ILMs. Enrichment analysis of Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathways implicated several genes with a left-right laryngeal muscle asymmetry. These genes are associated with neuronal and muscular physiology, immune/inflammatory response, and hormone control.

CONCLUSION

Bioinformatics analysis confirmed divergent transcriptome profiles between the left-right ILMs. This preliminary study identifies putative gene targets that will characterize ILM laterality.

LEVEL OF EVIDENCE

N/A Laryngoscope, 134:3741-3753, 2024.

Voice aspects in children with precocious puberty

PURPOSE

In this prospective study, we aimed to investigate the difference in voice acoustic parameters between girls with idiopathic central precocious puberty (ICPP) and those who developed normally during prepuberty.

MATERIALS AND METHODS

Our study recruited 54 girls diagnosed with ICPP and randomly sampled 51 healthy prepubertal girls as the control. Tanner stages, circulating hormone levels and bone ages of the girls with ICPP and the age and body mass index (BMI) of all participants were recorded. Acoustic analyses were performed using PRAAT computer-based voice analysis software and the mean pitch (F0), jitter, shimmer, noise-to harmonic-ratio (NHR) and harmonic-to-noise ratio (HNR) values were compared in the patient and control groups.

RESULTS

The two groups did not significantly differ in age or BMI. In the evaluation of the F0 and jitter values, we were found to be lower in the control group than in the patient group. However, we did not find a statistical significance. The mean shimmer values of the patient group were significantly higher than those of the control group. In addition, a statistically significant difference was noted for the mean HNR and NHR values (P < 0.001). A moderate negative correlation was found between shimmer and hormone levels in the patient group.

CONCLUSIONS

Voice acoustic parameters one of the defining features of girls with ICPP. Voice changes in acoustic parameters could reflect hormonal changes during puberty. Clinicians should suspect ICPP when there is a change in the voice.

Effect of Testosterone on the Thyroarytenoid Muscle and Lamina Propria of Female Rat Vocal Folds

OBJECTIVE

To analyze the effects of androgen therapy on the thyroarytenoid (TA) muscle, expression of androgen receptors (ARs) and hyaluronic acid (HA) concentration in the vocal folds (VFs) of adult female rats.

METHODS

Twenty-one adult female Wistar rats were divided into experimental and control groups. The experimental group received weekly intramuscular injections of nandrolone decanoate for 9 weeks. Following euthanasia and dissection of the VFs, histomorphometric analysis of the TA muscle, immunohistochemical evaluation of ARs, and measurement of HA concentration using the ELISA-like fluorimetric method were performed.

RESULTS

The experimental group exhibited a significantly larger mean fiber cross-sectional area in the TA muscle compared to the control group (434.3 ± 68.6 μm2 versus 305.7 ± 110.1 μm2; p = 0.029), indicating muscle hypertrophy. There was no significant difference in the number of muscle fibers. The experimental group showed higher expression of ARs in the lamina propria (62.0% ± 30.3% versus 22.0% ± 22.8%; p = 0.046) and in the TA muscle (45.0% ± 22.6% versus 18.3% ± 9.8%; p = 0.024). There was no significant difference in the concentration of HA.

CONCLUSION

Exposure of adult female rats to androgen therapy resulted in hypertrophy of the TA muscle and increased expression of ARs in the VFs. The TA muscle seems to be the primary target of testosterone action in the VF, and the up-regulation of ARs might contribute to the persistent deepening of the voice.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:2316-2321, 2024.

Vocal fold fibroblasts and exposure to vibration in vitro: Does sex matter?

Studies have shown that certain vocal fold pathologies are more common in one sex than the other. This is often explained by differences in the composition of the lamina propria and anatomical differences between female and male vocal folds, resulting in e.g. different fundamental frequencies. Here, we investigated a potential sex-specific voice frequency effect in an in vitro setting using vocal fold fibroblasts from one male and one female donor with and without cigarette smoke extract (CSE) addition. After exposure to either male or female vibration frequency with or without CSE, cells and supernatants were harvested. Gene and protein analysis were performed by means of qPCR, western blot, ELISA and Luminex. We found that exposure of cells to both male and female vibration pattern did not elicit significant changes in the expression of extracellular matrix-, inflammation-, and fibrosis-related genes, compared to control cells. The addition of CSE to vibration downregulated the gene expression of COL1A1 in cells exposed to the female vibration pattern, as well as induced MMP1 and PTGS2 in cells exposed to both female and male vibration pattern. The protein expression of MMP1 and COX2 was found to be significantly upregulated only in cells exposed to CSE and female vibration pattern. To conclude, different vibration patterns alone did not cause different responses of the cells. However, the female vibration pattern in combination with CSE had a tendency to elicit/maintain more pro-inflammatory responses in cells than the male vibration pattern.

The impact of tamoxifen treatment on voice parameters in premenopausal women with breast cancer

OBJECTIVE

The study aims to investigate the estrogen-agonistic effects of tamoxifen on voice parameters in premenopausal women diagnosed with breast cancer.

METHODS

A total of 108 premenopausal women were included, segmented into distinct treatment groups and a control group. Objective sound analysis was conducted using robust statistical methods, employing SPSS 25.0 for data analysis.

RESULTS

The study identified a statistically significant reduction in Jitter values across all treatment groups compared to the control group. No significant changes were observed in other voice quality parameters such as F0, Shimmer, NHR, and HNR.

CONCLUSIONS

The findings suggest that tamoxifen may have an estrogen-agonistic effect on voice quality, thereby potentially influencing future treatment protocols. This research fills a critical void in existing literature and sets the stage for more comprehensive studies that consider affects of hormonal therapies to voice.

Polycystic Ovary Syndrome and Alteration of Vocal Function: A Systematic Review and Meta-Analysis

INTRODUCTION

Polycystic ovary syndrome (PCOS) is a common hormonal disorder among young women, correlated with hyperandrogenism. Among the symptoms of PCOS, vocal alterations are quite unknown. Dysphonia may be related to hyperandrogenism, and there is no consensus about its prevalence and the severity of vocal disorders, which can cause noticeable discomfort.

METHODS

A systematic review of the literature was conducted. Four studies on PCOS that evaluated the phonatory system were included for a total of 174 patients (96 PCOS, 78 controls), and a meta-analysis on comparable data was performed.

RESULTS

Four studies evaluated parameters related to vocal symptomatology, altered audiometric examination, and findings at the laryngoscopy in patients affected by PCOS versus controls. Although the individual studies showed increased incidence of alterations and a tendency to develop speech fatigue in women with PCOS, when the results of studies were pulled in meta-analysis, the overall difference was not statistically significant. The studies themselves were very different from each other; therefore, it is hard to draw any firm conclusions.

DISCUSSION

The aim of this study was to assess the prevalence of vocal alterations, the correlation with hyperandrogenism, the quality of life, and the voice changes after starting a therapy for PCOS. The present meta-analysis failed to find any difference in terms of PCOS and control cohort. However, the lack of high-quality studies makes it difficult to draw firm conclusions. New and larger studies or big population program data are therefore warranted.

[Optimization of an integrated approach to voice correction for endocrinopathies (analytical review)]

Dysphonia is a symptom of many endocrine pathologies. Hoarseness, voice fatigue, decrease of the voice pitch, reduce of the range are typical complaints for hypothyroidism, caused by an increased amount of polysaccharides and accumulation of fluid in the lamina propria of the vocal folds. An excess of growth hormone causes an overproduction of insulin-like growth factor-1, which leads to abnormalities in the craniofacial region and proliferation of the upper respiratory tract tissues, including thickening of the laryngeal cartilages, vocal folds and decreasing of the voice pitch. Hyperglycemia, changes in the balance of fluid and electrolytes in diabetes mellitus can indirectly affect the voice: xerostomia complicates phonation due to impaired hydration of the laryngeal mucosa, diabetic neuropathy often disrupts the work of the laryngeal muscles involved in voice formation. Voice changes are observed not only in endocrine disorders, but also during puberty, the phases of the menstrual cycle and during menopause. Laryngeal structures are modified under the influence of hormones and external factors, which generally changes pitch and intensity of the voice, timbre and resonance, articulation and prosodic characteristics. The purpose of this review is to summarize and systematize data on physiological and pathological voice changes in patients of different age groups and sex. The possibilities of a multidisciplinary approach to rational voice correction are demonstrated.

Effect of sex hormones on human voice physiology: from childhood to senescence

The aim of the present literature review is to describe the influence of sex hormones on the human voice in physiological conditions. As a secondary sexual organ, the larynx is affected by sex hormones and may change considerably over the lifespan. In the current review, sex hormone-related voice modifications occurring during childhood, puberty, the menstrual cycle, pregnancy and senescence are described. The roles of sex hormones (including gonadotropins, testosterone, estrogen, androstenedione, dehydroepiandrosterone, and dehydroepiandrosterone-sulfate) underlying physiological voice changes are discussed, the main differences between males and females are explained and clinical implications are taken into account.

Kymographic characteristics of voice in women with Polycystic ovary syndrome

PURPOSE

Polycystic ovary syndrome (PCOS) is heterogenous condition with commonly associated symptoms include irregular menstrual cycle, hirsutism, baldness, adult acne, and weight gain There have been few attempts at profiling the voice characteristics of women with polycystic ovary syndrome. Videokymography enables to detect even subtle variationsin vocal fold vibrations. The aim of the present study was to study the videokymographic characteristics among women with PCOS.

METHODS

A cross-sectional study was carried out among 50 women with and without PCOS diagnosed on ultrasonography. Videokymography was carried out and the characteristics were perceptually analyzed using a vocal fold kymographic rating scale. The analysis of the kymogram was done for the following characteristics; presence of vocal fold vibration,interference of surroundings, Cycle to cycle variability, left-right asymmetry,cycle aberrations and shape of lateral peaks. The kymographic images were obtained for all the participants of both the groups and a subjective consensus evaluation was done by two clinicians. The percentage of participants with the listed kymographic characteristics were tabulated. Chi Square test was also done to decide if there was a significant difference between the two groups for different kymographic features of vocal fold vibration.

RESULTS

Six of the 25 women with PCOS were found to have abnormal kymographic features such as surrounding structural interference, presence of cycle to cycle variability and the shape of lateral peaks.

CONCLUSION

Early detection of the vocal abnormalities in individuals with PCOS would help in the vocal rehabilitation especially for professional voice users.

Testosterone therapy masculinizes speech and gender presentation in transgender men

Voice is one of the most noticeably dimorphic traits in humans and plays a central role in gender presentation. Transgender males seeking to align internal identity and external gender expression frequently undergo testosterone (T) therapy to masculinize their voices and other traits. We aimed to determine the importance of changes in vocal masculinity for transgender men and to determine the effectiveness of T therapy at masculinizing three speech parameters: fundamental frequency (i.e., pitch) mean and variation (fo and fo-SD) and estimated vocal tract length (VTL) derived from formant frequencies. Thirty transgender men aged 20 to 40 rated their satisfaction with traits prior to and after T therapy and contributed speech samples and salivary T. Similar-aged cisgender men and women contributed speech samples for comparison. We show that transmen viewed voice change as critical to transition success compared to other masculine traits. However, T therapy may not be sufficient to fully masculinize speech: while fo and fo-SD were largely indistinguishable from cismen, VTL was intermediate between cismen and ciswomen. fo was correlated with salivary T, and VTL associated with T therapy duration. This argues for additional approaches, such as behavior therapy and/or longer duration of hormone therapy, to improve speech transition.

Comparison of Fundamental Frequency in Postmenopausal Women Who Are Treated With Hormone Replacement Therapy vs Those Who Are Not: A Systematic Review and Meta-analysis

Importance

Hormonal changes during menopause have been associated with significant changes in voice. Although hormone replacement therapy (HRT) is used primarily to manage systemic symptoms of menopause, its association with voice in postmenopausal women has not been adequately investigated by large-scale studies.

Objective

To compare fundamental frequency between postmenopausal women who used HRT and those who did not use HRT.

Data Sources

PubMed, Ovid MEDLINE, CINAHL, Cochrane EBM Reviews, and Embase were searched from 1946 to February 19, 2020.

Study Selection

Studies included in the final review were those in English that compared voice outcomes in postmenopausal women who were or were not receiving HRT for treatment of climacteric symptoms associated with menopause.

Data Extraction and Synthesis

The study was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data extraction was performed by 2 independent investigators. Study quality was assessed using a validated quality tool. Whenever possible, data were pooled using random-effects meta-analysis.

Main Outcomes and Measures

The primary outcome was the difference in speaking fundamental frequency (F0) between HRT users and nonusers. Subgroup analysis of the primary outcome was based on body mass index (BMI) using a cutoff value of 25. A BMI of 18.5 to 24.9 is considered normal, and a BMI of at least 25 is considered overweight. Secondary outcomes included other objective measurements of voice, including jitter and shimmer.

Results

A total of 937 records were screened, 18 full texts were assessed, and 11 studies were included in the final review. All 11 studies were case-control studies and were rated from fair to good quality based on the Newcastle-Ottawa Scale. A total of 5 studies including 154 participants who received HRT and 154 controls were used for meta-analysis. The mean (SD) F0 was 185.9 (8.6) Hz for HRT users compared with 174.6 (6.6) Hz for nonusers. Hormone replacement therapy was associated with a higher mean F0 by a difference of 11.85 Hz (95% CI, 7.35-16.36 Hz). Subgroup analysis showed that the change in F0 was significant in postmenopausal women with a normal body mass index (mean difference, 13.47 Hz; 95% CI, 8.48-18.46 Hz) but not in those with a high body mass index.

Conclusions and Relevance

Existing evidence suggests that HRT is associated with a higher F0 in postmenopausal women. The effectiveness of the treatment appeared to be more pronounced in women with a normal body mass index.

Vocal Indicators of Size, Shape and Body Composition in Polish Men

OBJECTIVES

From a human evolution perspective, identifying a link between physique and vocal quality could demonstrate dual signaling in terms of the health and biological condition of an individual. In this regard, this study investigates the relationship between men's body size, shape, and composition, and their vocal characteristics.

MATERIALS AND METHODS

Eleven anthropometric measurements, using seven indices, were carried out with 80 adult Polish male participants, while the speech analysis adopted a voice recording procedure that involved phonetically recording vowels /ɑː/, /ɛː/, /iː/, /ɔː/, /uː/ to define the voice acoustic components used in Praat software.

RESULTS

The relationship between voice parameters and body size/shape/composition was found. The analysis indicated that the formants and their derivatives were useful parameters for prediction of height, weight, neck, shoulder, waist, and hip circumferences. Fundamental frequency (F₀) was negatively correlated with neck circumference at Adam's apple level and body height. Moreover neck circumference and F₀ association was observed for the first time in this paper. The association between waist circumference and formant component showed a net effect. In addition, the formant parameters showed significant correlations with body shape, indicating a lower vocal timbre in men with a larger relative waist circumference.

DISCUSSION

Men with lower vocal pitch had wider necks, probably a result of larynx size. Furthermore, a greater waist circumference, presumably resulting from abdominal fat distribution in men, correlated with a lower vocal timbre. While these results are inconclusive, they highlight new directions for further research.

Fundamental Frequency Variations Across the Menstrual Cycle and the Use of an Oral Contraceptive Pill

Purpose Concentrations of sex steroid hormones-estrogens, progesterone, and testosterone-have been associated with premenstrual and menstrual vocal symptoms. However, the extent to which these symptoms may be reflected on acoustical features of the voice is still debated. This study investigates variations in fundamental frequency (f _o) and related parameters in connected speech across phases of the menstrual cycle and during the use of a combined oral contraceptive pill (OCP). Method Electrolaryngographic recordings were made, and blood samples were collected at three different phases of the menstrual cycle-menstrual, follicular, and luteal-for placebo and OCP use. These two conditions were blindly and randomly allocated in the study. Speaking f _o (SFF), SFF standard deviation, SFF rate of change, SFF slope, maximum and minimum f _o, and f _o range were extracted for nine healthy females while reading a phrase from the Rainbow Passage. Concentrations of sex hormones were analyzed in serum. Nonparametric statistical tests were carried out to assess differences between phases and conditions. Results SFF, its standard deviation, and maximum f _o were significantly different between phases of the menstrual cycle for placebo use only. Menstrual phase showed the lowest values. Maximum and minimum f _o were significantly different between placebo and OCP use for menstrual and follicular phases, respectively. Conclusions Fluctuations in sex steroid hormones across the menstrual cycle alter f _o in speech more than a particular hormonal concentration. OCP use seems to have a stabilizing effect on the voice relative to f _o and related parameters in speech.

Loss of Estrogen Receptors is Associated with Increased Tumor Aggression in Laryngeal Squamous Cell Carcinoma

Laryngeal squamous cell carcinoma (LSCC) responds to 17β-estradiol via estrogen-receptor (ER, transcribed from ESR1) dependent mechanisms, but is not recognized as a hormonally responsive cancer. 17β-estradiol production by LSCC cell lines UM-SCC-11A and UM-SCC-12 was examined. Wild type (WT) and ESR1-silenced LSCC cultures and xenografts were examined for 17β-estradiol responsiveness in vivo. 14 LSCC and surrounding epithelial samples at various pathological stages were obtained from patients; ERα and ERβ expression were verified using data from the total cancer genome atlas. UM-SCC-11A and UM-SCC-12 both produce 17β-estradiol, but only UM-SCC-12, not UM-SCC-11A, xenograft tumors grow larger in vivo in response to systemic 17β-estradiol treatments. ERα66 and ERα36 expression inversely correlated with clinical cancer stage and tumor burden. LSCC ERα66 expression was higher compared to surrounding epithelia in indolent samples but lower in aggressive LSCC. ERβ expression was highly variable. High ESR1 expression correlated with improved survival in LSCC. Loss of ERα66 expression inversely correlated with prognosis in LSCC. ERα66 may be a histopathological marker of aggression in LSCC.

Physiological and perceptual correlates of masculinity in children's voices

Low frequency components (i.e. a low pitch (F0) and low formant spacing (ΔF)) signal high salivary testosterone and height in adult male voices and are associated with high masculinity attributions by unfamiliar listeners (in both men and women). However, the relation between the physiological, acoustic and perceptual dimensions of speakers' masculinity prior to puberty remains unknown. In this study, 110 pre-pubertal children (58 girls), aged 3 to 10, were recorded as they described a cartoon picture. 315 adults (182 women) rated children's perceived masculinity from the voice only after listening to the speakers' audio recordings. On the basis of their voices alone, boys who had higher salivary testosterone levels were rated as more masculine and the relation between testosterone and perceived masculinity was partially mediated by F0. The voices of taller boys were also rated as more masculine, but the relation between height and perceived masculinity was not mediated by the considered acoustic parameters, indicating that acoustic cues other than F0 and ΔF may signal stature. Both boys and girls who had lower F0, were also rated as more masculine, while ΔF did not affect ratings. These findings highlight the interdependence of physiological, acoustic and perceptual dimensions, and suggest that inter-individual variation in male voices, particularly F0, may advertise hormonal masculinity from a very early age.

Estrogen signaling and estrogen receptors as prognostic indicators in laryngeal cancer

Laryngeal squamous cell carcinoma (LSCC) has been shown to respond to 17β-estradiol. However, the presence and characterization of estrogen receptors (ER) and other sex hormone receptors in LSCC are still being determined. Sex hormone receptors and the way sex hormones impact LSCC tumors are important for understanding which patients would benefit from hormone therapies, such as anti-estrogen therapies. This information also has prognostic value, as there may be a correlation between ER profiles and LSCC aggression. Recent work by our team and others has shown that the canonical ER, estrogen receptor α (ERα), and its splice variant ERα36, are important modulators of estrogen signaling in LSCC. This review describes some common 17β-estradiol signaling pathways, and explains how these signaling pathways might control LSCC tumor growth. We also show that loss of ERα, but not ERα36, imbues LSCC with enhanced aggression, a pattern which has previously only been observed in breast cancer. We make a case for using ERα as a tumorigenic modulator and pathogenic marker in LSCC on par with the use of ERα as a prognostic marker in breast cancer.

Transmasculine Voice Modification: A Case Study

This case study measured the effects of manual laryngeal therapy on the fundamental frequency (f_o), formant frequencies, estimated vocal tract length, and listener perception of masculinity of a 32-year-old transmasculine individual. The participant began testosterone therapy 1.5 years prior to the study. Two therapy approaches were administered sequentially in a single session: (1) passive circumlaryngeal massage and manual laryngeal reposturing, and (2) active laryngeal reposturing with voicing. Acoustic recordings were collected before and after each treatment and 3 days after the session. Speaking f_o decreased from 124 Hz to 120 Hz after passive training, and to 108 Hz after active training. Estimated vocal tract length increased from 17.0 cm to 17.3 cm after passive training, and to 19.4 cm after active training. Eight listeners evaluated the masculinity of the participant's speech; his voice was rated as most masculine at the end of the training session. All measures returned to baseline at follow-up. Overall, both acoustic and perceptual changes were observed in one transmasculine individual who participated in manual laryngeal therapy, even after significant testosterone-induced voice changes had already occurred; however, changes were not maintained in the follow-up. This study adds to scant literature on effective approaches to and proposed outcome measures for voice masculinization in transmasculine individuals.

Old and young female voices: effects of body weight, condition and social discomfort on the vocal aging in red deer hinds (Cervus elaphus)

In female terrestrial mammals, vocal aging has only been studied in humans and pandas. In cervids displaying convergent sex dimorphism of vocal apparatus with humans, vocal aging is only investigated in males. This cross-sectional study examined acoustic variables of nasal (closed-mouth) and oral (open-mouth) contact calls of 32 farmed Iberian red deer hinds (Cervus elaphus hispanicus) aged of 4-18 years and their relationships with caller´s age, weight, social discomfort score (bites of other hinds on hind pelt) and body condition score (fat reserves). Decrease of fundamental frequency was associated with age in both oral and nasal calls, but more prominently in the nasal calls. An increase in call duration, peak frequency and power quartiles was associated with a higher degree of bites due to social aggression. Weight and body condition weakly influenced acoustic traits. We discuss that vocal aging of hinds parallels that of vocal aging in human females.

Magnetic Resonance Imaging of the Vocal Folds in Women With Congenital Adrenal Hyperplasia and Virilized Voices

PURPOSE

Women with congenital adrenal hyperplasia (CAH) may develop a virilized voice due to late diagnosis or suboptimal suppression of adrenal androgens. Changes in the vocal folds due to virilization have not been studied in vivo. The purpose was to investigate if the thyroarytenoid (TA) muscle is affected by virilization and correlate findings to fundamental frequency (F0).

METHOD

A case-control study using magnetic resonance imaging and voice recordings. Four women with CAH with virilized voices (26-40 years), and 5 female and 4 male controls participated. Measurements of cross-sectional TA muscle area, vocal fold length, vocal tract length, and acoustic analyses of F0 were performed.

RESULTS

Women with CAH had larger cross-sectional TA muscle area than female control subjects and smaller than male controls. A significant negative correlation was found between TA muscle area and mean F0. The patients had a smaller physiological voice range than both female and male controls.

CONCLUSION

Data from our small study suggest that a larger TA muscle area is strongly associated with a lower F0 and thus the anatomical explanation for a female virilized voice, suggesting an androgen effect on the vocal folds. The findings from the present study need to be confirmed in a larger study.

Electrical stimulation and testosterone enhance recovery from recurrent laryngeal nerve crush

OBJECTIVE

This study investigated the effects of a combinatorial treatment, consisting of a brief period of nerve electrical stimulation (ES) and systemic supraphysiologic testosterone, on functional recovery following a crush of the recurrent laryngeal nerve (RLN).

STUDY DESIGN

Prospective, controlled animal study.

METHODS

After a crush of the left RLN, adult male Sprague-Dawley rats were divided into four treatment groups: 1) no treatment, 2) ES, 3) testosterone propionate (TP), and 4) ES + TP. Each group was subdivided into 1, 2, 3, or 4 weeks post-operative survival time points. Groups had an n of 4- 9. Recovery of vocal fold mobility (VFM) was assessed.

RESULTS

Brief ES of the proximal nerve alone or in combination with TP accelerated the initiation of functional recovery. TP administration by itself also produced increased VFM scores compared to controls, but there were no statistical differences between the ES-treated and TP-treated animals. Treatment with brief ES alone was sufficient to decrease the time required to recover complete VFM. Animals with complete VFM were seen in treatment groups as early as 1 week following injury; in the untreated group, this was not observed until at least 3 weeks post-injury, translating into a 66% decrease in time to complete recovery.

CONCLUSIONS

Brief ES, alone or in combination with TP, promise to be effective therapeutic interventions for promoting regeneration following RLN injury.

The assessment of the impact of anorexia nervosa on the vocal apparatus in adolescent girls - A preliminary report

BACKGROUND

Chronic undernourishment in the course of anorexia nervosa leads to various metabolic and hormonal changes, which translates to the impaired functioning of the majority of systems and internal organs. The impact of eating disorders on the condition of the vocal apparatus has been described in the literature; nevertheless, it concerns mainly bulimia nervosa.

OBJECTIVES

assessment of the vocal apparatus in adolescent girls diagnosed with anorexia nervosa from the point of view of possible influence on the function and structure of the larynx, low body mass accompanying anorexia, as well as energy deficiency, hormonal and emotional disturbances.

MATERIALS AND METHODS

The research included 41 girls aged 12-19 years, diagnosed with anorexia, who were assessed for the condition of the vocal apparatus, using the perceptual assessment of voice according to GRBAS scale, videolarynostroboscopy, acoustic assessment, and voice self-assessment in Jacobson's VHI scale (voice handicap index).

RESULTS

The perceptual assessment of voice using the GRBAS scale revealed that changes in voice were mainly weak, asthenic in nature (70.73%) and there was also the feature of puffing perceived in voice (41.46%). In voice self-assessment with the use of VHI, most subjects seemed to point to changes of voice self-perception in emotional subscale (68%). Videolaryngostroboscopy revealed some features of functional disturbances of voice in more than half of subjects, mainly in the form of hyperfunctional dysphonia (31.78%). The maximal phonation time was significantly shorter, in proportion to duration of the primary disease. In the acoustic analysis, the decrease in the basic frequency F0 and narrowing of the voice scale were observed. 55% of older, post-adolescent patients presented with the structure of the larynx that was inappropriate for their age.

CONCLUSIONS

These results might indicate that anorexia nervosa could have led to the structural and functional changes in the vocal apparatus. Such disturbances may be explained by the hormonal dysfunctions as well as starvation. Hormonal substitution at the appropriate time might be beneficial for the structure and phonation function of the larynx in girls with AN.

The Effect of Menstrual Cycle on Singing Voice: A Systematic Review

OBJECTIVE

Research has reported the difference in a woman's voice across the different stages of the menstrual cycle. A review of the studies in singers on the influence of menstruation on the singing voice will enable a better understanding of these changes.

METHODS/DESIGN

A systematic literature search was carried out on PubMed, CINAHL, Scopus, Cochrane, and regional electronic databases. The keywords "menstrual cycle," "voice change," and "singer" were used in different combinations. Only those articles that discussed the effect of menstrual cycle on the singing voice were included in the final review.

RESULTS

Six studies in the English language were identified and included in the review. Hormonal variations occur to a great extent during menstrual cycle, and these variations can influence the voice of singers. A great variability was found in the included studies. There are limited studies that have been carried out exploring the relationship between menstrual cycle and the singing voice.

CONCLUSION

Even though the studies included in the review point out toward the changes in the singing voice associated with menstrual cycle, there is a need for more studies to be carried out in diverse singing populations and in different outcome measures.

Effect of testosterone therapy on the female voice

OBJECTIVES

This prospective study was designed to investigate the effect of testosterone, delivered by subcutaneous implants, on the female voice.

METHODS

Ten women who had opted for testosterone therapy were recruited for voice analysis. Voices were recorded prior to treatment and at 3 months, 6 months, and 12 months while on testosterone therapy. Acoustic samples were collected with subjects reading a sentence, reading a paragraph, and participating in a conversation. Significant changes in the voice over time were investigated using a repeated-measures analysis of variance with the fundamental frequency (F0) as a response variable. Demographic variables associated with characteristics of the voice were assessed.

RESULTS

There were no significant differences in average F0 related to smoking history, menopausal status, weight, or body mass index. There was no difference in average fundamental speaking frequency (sentence, paragraph, conversation) between the pre-treatment group and any post-treatment group at 3 and 12 months. There was an increase in sentence speech F0 at 6 months. Two of three patients with lower than expected F0 at baseline improved on testosterone therapy.

CONCLUSION

Therapeutic levels of testosterone, delivered by subcutaneous implant, had no adverse affect on the female voice including lowering or deepening of the voice.

Fundamental Frequency of Crying in Two-month-old Boys and Girls: Do Sex Hormones During Mini-puberty Mediate Differences?

OBJECTIVE

To evaluate whether the puberty-like sex hormone surge during the first months of life (mini-puberty) affects fundamental frequency (fo) in infant crying as one would derive from hormone influences on voice in adults.

STUDY DESIGN

Populational prospective study.

PARTICIPANTS

Twenty healthy normal-hearing infants (nine boys) were recruited for participation.

METHODS

Spontaneously uttered cries were collected from each infant at 8 weeks of age. The cries were acoustically analyzed for mean fo and fo range. The fo properties were correlated to the average serum levels of bioavailable estradiol (E2) (mean E2/sex hormone-binding globulin [SHBG]) and testosterone (T) (mean T/SHBG) across the second month of life.

RESULTS

Whereas no significant hormone effect was found for mean fo, a significant negative correlation (r = -0.55) was found between fo range and mean E2/SHBG. No indication for a T influence on fo features was found at this age. Although girls showed a slightly higher mean E2 concentration than boys did, the observed differences in cry fo range were judged to be reflective of an infant's serum concentration of E2 rather than a sex-based difference.

CONCLUSION

In the absence of laryngeal size differences between female and male infants, the result was interpreted as indicative of an E2 influence on viscoelastic properties of the vocal folds. In our opinion, the investigation of young infants' vocalizations during the early postnatal surge of sex steroids (mini-puberty) may advance our understanding of the mechanisms mediating average sex differences in vocal development and early communication.

Functional Voice Testing Detects Early Changes in Vocal Pitch in Women During Testosterone Administration

OBJECTIVE

To determine dose-dependent effects of T administration on voice changes in women with low T levels.

METHODS

Seventy-one women who have undergone a hysterectomy with or without oophorectomy with total T < 31 ng/dL and/or free T < 3.5 pg/mL received a standardized transdermal estradiol regimen during the 12-week run-in period and were then randomized to receive weekly im injections of placebo or 3, 6.25, 12.5, or 25 mg T enanthate for 24 weeks. Total and free T levels were measured by liquid chromatography-tandem mass spectrometry and equilibrium dialysis, respectively. Voice handicap was measured by self-report using a validated voice handicap index questionnaire at baseline and 24 weeks after intervention. Functional voice testing was performed using the Kay Elemetrics-Computer Speech Lab to determine voice frequency, volume, and harmonics.

RESULTS

Forty-six women with evaluable voice data at baseline and after intervention were included in the analysis. The five groups were similar at baseline. Mean on-treatment nadir total T concentrations were 13, 83, 106, 122, and 250 ng/dL in the placebo, 3-, 6.25-, 12.5-, and 25-mg groups, respectively. Analyses of acoustic voice parameters revealed significant lowering of average pitch in the 12.5- and 25-mg dose groups compared to placebo (P < .05); these changes in pitch were significantly related to increases in T concentrations. No significant dose- or concentration-dependent changes in self-reported voice handicap index scores were observed.

CONCLUSION

Testosterone administration in women with low T levels over 24 weeks was associated with dose- and concentration-dependent decreases in average pitch in the higher dose groups. These changes were seen despite the lack of self-reported changes in voice.

Is Menstrual Dysphonia Associated With Greater Disability and Lower Quality of Life?

OBJECTIVES

The aim of the present study had been to examine the relationships between menstrual dysphonia and measures of psychosocial distress, in a sample of female professional voice users.

DESIGN AND METHODS

This is a prospective study of 52 consecutive professional voice users, aged 18-40 years, affected by transient dysphonia related to the menstrual cycle and recruited in the Division of Phoniatrics and Audiology of the Second University of Naples, from April 2011 to September 2014. The following evaluation protocol was used: videoendoscopy, the GIRBAS scale, the Voice Handicap Index, and the determination of sexual hormonal plasma levels both during the menstrual and the luteal phase of the cycle. Furthermore, we measured, in all patients, the levels of perceived disability and quality of life during and after the dysphonia episodes by means of the Manchester Short Assessment of Quality of Life and the Sheehan disability scale.

RESULTS

Laryngoscopic evaluation revealed that only minor morphologic changes were present during the first days of the follicular phase, usually returning to normal morphology after the menstrual period was over. However, we found that dysphonia episodes of varying degree were present in most evaluated subjects; women with a moderate degree of dysphonia also had a lower quality of life and greater overall disability, during menses.

CONCLUSIONS

Despite minimal morphologic signs of laryngeal pathology, menstrual dysphonia might represent a disease which is frequent among female professional voice users, which in turn is associated with a certain degree of disability and lower quality of life during premenstrual and menstrual phases.

Cues to androgens and quality in male gibbon songs

Animal vocal signals may provide information about senders and mediate important social interactions like sexual competition, territory maintenance and mate selection. Hence, it is important to understand whether vocal signals provide accurate information about animal attributes or status. Gibbons are non-human primates that produce loud, distinctive and melodious vocalizations resembling more those of birds than of other non-human primates. Wild gibbons are characterized by flexibility in social organization (i.e., pairs and multimale units) as well as in mating system (i.e., monogamy and polyandry). Such features make them a suitable model to investigate whether the physiology (hormonal status) and socio-demographic features find their correspondence in the structure of their songs. By combining male solo song recordings, endocrine outputs using non-invasive fecal androgen measures and behavioral observations, we studied 14 groups (10 pair-living, 4 multimale) of wild white-handed gibbons (Hylobates lar) residing at Khao Yai National Park, Thailand. We collected a total of 322 fecal samples and recorded 48 songs from 18 adult animals. Our results confirmed inter-individuality in male gibbon songs, and showed a clear correlation between androgen levels and song structures. Gibbons with higher androgen levels produced calls having higher pitch, and similarly adult individuals produced longer calls than senior males. Thus, it is plausible that gibbon vocalizations provide receivers with information about singers' attributes.

Signaling in multiple modalities in male rhesus macaques: sex skin coloration and barks in relation to androgen levels, social status, and mating behavior

The past decade has seen an increasing shift in animal communication towards more studies that incorporate aspects of signaling in multiple modalities. Although nonhuman primates are an excellent group for studying the extent to which different aspects of condition may be signaled in different modalities, and how such information may be integrated during mate choice, very few studies of primate species have incorporated such analyses. Here, we present data from free-ranging male rhesus macaques on sex skin coloration (modeled to receiver perception), bark vocal signals, androgen levels, morphometric variables, dominance status, and female mate choice. We show that, consistent with data on females, most intra- and interindividual variation in sex skin appearance occurs in luminance rather than color. Sex skin luminance was significantly correlated across different skin regions. Sex skin luminance did not correlate with the majority of bark parameters, suggesting the potential for the two signals to convey different information. Sex skin appearance was not related to androgen levels although we found some evidence for links between androgen levels and bark parameters, several of which were also related to morphometric variables. We found no evidence that either signal was related to male dominance rank or used in female mate choice, though more direct measures of female proceptive behavior are needed. Overall, the function of male sex skin coloration in this species remains unclear. Our study is among the first nonhuman primate studies to incorporate measurements of multiple signals in multiple modalities, and we encourage other authors to incorporate such analyses into their work.

G protein-coupled estrogen receptor 1 expression in human vocal fold

OBJECTIVES/HYPOTHESIS

Besides the classical sexual receptors, the expression of a recently clarified transmembrane G protein-coupled receptor (GPR30) has not been reported in the vocal fold so far. We aimed to study whether GPR30 is expressed in the human vocal fold.

STUDY DESIGN

Experimental study using pathologic human vocal fold tissues.

METHODS

Reverse-transcription polymerase chain reaction and immunohistochemistry were used to detect the GPR30 expression in a total of 83 vocal fold samples.

RESULTS

A total of 66% of the specimens tested were GPR30 mRNA positive, and 54% of the sections were revealed to be GPR30 immunostaining positive in the plasma membrane as well as the nucleus in the epithelial cells.

CONCLUSIONS

The GPR30 expression both in mRNA and protein level could be detected in the human vocal fold.

Women's attractiveness changes with estradiol and progesterone across the ovulatory cycle

In many species, females are more sexually attractive to males near ovulation. Some evidence suggests a similar pattern in humans, but methodological limitations prohibit firm conclusions at present, and information on physiological mechanisms underlying any such pattern is lacking. In 202 normally-cycling women, we explored whether women's attractiveness changed over the cycle as a function of two likely candidates for mediating these changes: estradiol and progesterone. We scheduled women to attend one session during the late follicular phase and another during the mid-luteal phase. At each session, facial photographs, voice recordings and saliva samples were collected. All photographs and voice recordings were subsequently rated by men for attractiveness and by women for flirtatiousness and attractiveness to men. Saliva samples were assayed for estradiol and progesterone. We found that progesterone and its interaction with estradiol negatively predicted vocal attractiveness and overall (facial plus vocal) attractiveness to men. Progesterone also negatively predicted women's facial attractiveness to men and female-rated facial attractiveness, facial flirtatiousness and vocal attractiveness, but not female-rated vocal flirtatiousness. These results strongly suggest a pattern of increased attractiveness during peak fertility in the menstrual cycle and implicate estradiol and progesterone in driving these changes.

Vocal symptoms in women undergoing in vitro fertilization

OBJECTIVE

The aim of this study was to investigate changes in vocal symptoms in relation to estrogen level in women undergoing in vitro fertilization.

MATERIALS AND METHODS

A total of 31 women were enrolled in this study. The following vocal symptoms were investigated: vocal tiring or fatigue, vocal straining, throat clearing, lump sensation, hoarseness, and aphonia (or loss of voice). The severity of these symptoms was graded from 0 to 4, where 0 means absence of the symptom and 3 means severe symptom presence. The frequency of these symptoms was evaluated in the first visit at presentation; second visit, 4 to 5 days after ovarian stimulation; and third visit, 8 to 10 days after stimulation. In the second and third visits, the estradiol levels were measured.

RESULTS

The mean age was 32.33 ± 4.80 years. Ten of the 31 patients had at least 1 vocal symptom. The most common vocal symptom in all 3 visits was throat clearing, with an incidence of 22.6% in the first and second visits and 19.4% in the third visit. This was followed by vocal fatigue or tiring and lump sensation, with an incidence of 9.68% for both. The incidence of all the vocal symptoms as well as their severity did not change throughout the visits, except for throat clearing, which has decreased in the third visit but not significantly (22.6% vs 19.4%, P = 1). Subjects with vocal symptoms had lower estradiol level compared with those with no vocal symptoms; however, the difference was not statistically significant (P = .108 and .267, respectively).

CONCLUSION

Subjects undergoing in vitro fertilization do not experience changes in their vocal symptoms when present, except for throat clearing. However, those with vocal symptoms have lower levels of estradiol compared with those with no vocal symptoms.

Low pitched voices are perceived as masculine and attractive but do they predict semen quality in men?

Women find masculinity in men's faces, bodies, and voices attractive, and women's preferences for men's masculine features are thought to be biological adaptations for finding a high quality mate. Fertility is an important aspect of mate quality. Here we test the phenotype-linked fertility hypothesis, which proposes that male secondary sexual characters are positively related to semen quality, allowing females to obtain direct benefits from mate choice. Specifically, we examined women's preferences for men's voice pitch, and its relationship with men's semen quality. Consistent with previous voice research, women judged lower pitched voices as more masculine and more attractive. However men with lower pitched voices did not have better semen quality. On the contrary, men whose voices were rated as more attractive tended to have lower concentrations of sperm in their ejaculate. These data are more consistent with a trade off between sperm production and male investment in competing for and attracting females, than with the phenotype-linked fertility hypothesis.

Female hormonal and reproductive factors and head and neck squamous cell carcinoma risk

Men are much more likely than women to develop head and neck squamous cell carcinoma (HNSCC), a discrepancy that is insufficiently explained by gender differences in smoking and alcohol consumption. It has been hypothesized that differential hormonal exposures may account for some of this risk but thus far the literature on female reproductive factors and HNSCC risk has been sparse. To address the association of HNSCC with female hormonal and reproductive factors, a case-control study was conducted on 149 women with head and neck cancer and 158 controls. After adjusting for potential confounding, postmenopausal women using female hormones for more than 5 years showed a borderline protective effect for HNSCC (adjusted OR = 0.47, 95% CI: 0.20-1.08), with a borderline trend across duration of use categories (P = 0.06). There was no association of HNSCC with age at menarche, hysterectomy/oophorectomy status, oral contraceptive use, history of fertility medication, or number of pregnancies, parity, or age at first pregnancy or live birth. The findings of this study do not support a link between HNSCC and reproductive factors, although the borderline association with HRT warrants further investigation.

Estrogen and Progestogen Correlates of the Structure of Female Copulation Calls in Semi-Free-Ranging Barbary Macaques (Macaca sylvanus)

Females of many Old World primates produce conspicuous vocalizations in combination with copulations. Indirect evidence exists that in Barbary macaques (Macaca sylvanus), the structure of these copulation calls is related to changes in reproductive hormone levels. However, the structure of these calls does not vary significantly around the timing of ovulation when estrogen and progestogen levels show marked changes. We here aimed to clarify this paradox by investigating how the steroid hormones estrogen and progesterone are related to changes in the acoustic structure of copulation calls. We collected data on semi-free-ranging Barbary macaques in Gibraltar and at La Forêt des Singes in Rocamadour, France. We determined estrogen and progestogen concentrations from fecal samples and combined them with a fine-grained structural analysis of female copulation calls (N = 775 calls of 11 females). Our analysis indicates a time lag of 3 d between changes in fecal hormone levels, adjusted for the excretion lag time, and in the acoustic structure of copulation calls. Specifically, we found that estrogen increased the duration and frequency of the calls, whereas progestogen had an antagonistic effect. Importantly, however, variation in acoustic variables did not track short-term changes such as the peak in estrogen occurring around the timing of ovulation. Taken together, our results help to explain why female Barbary macaque copulation calls are related to changes in hormone levels but fail to indicate the fertile phase.

Voice characteristics in women with congenital adrenal hyperplasia due to 21-hydroxylase deficiency

OBJECTIVE

Congenital adrenal hyperplasia (CAH) is an autosomal recessive inherited disorder resulting in lack of cortisol and often aldosterone and overproduction of androgens. Raised levels of androgens can lead to increased mass in the laryngeal tissues, which may lower the fundamental frequency (F0) of the voice.

DESIGN/PATIENTS

A follow-up study of voice characteristics in 38 women with CAH and 24 age-matched controls between 18 and 63 years of age using subjective self-ratings of voice symptoms and acoustic and perceptual analyses. The results were correlated to mutation and treatment.

MEASUREMENTS

The subjects rated degree of hoarseness, dark voice, voice problems and vocal fatigue on visual analogue scales. Audio recordings were made of a standard reading passage in a sound treated booth. Acoustic analyses were made of the subjects' mean, minimum and maximum F0 in the habitual speech range. Three voice clinicians made perceptual evaluations of dark voice in terms of timbre.

RESULTS

Women with CAH rated higher values than controls with regard to the statement 'my voice is a problem in my daily life'. They spoke with significantly lower mean, lower minimum and lower maximum F0, as well as darker voice quality as compared with the controls. Affected voice symptoms were associated with a late diagnosis or problems with medication.

CONCLUSION

The voices in women with CAH can be virilized because of late diagnosis or suboptimal treatment with glucocorticoids. These voice problems may need referral for voice assessment and should be considered when treating CAH.