The Expression of Estrogen and Progesterone Receptors in the Human Larynx

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.

Sociodemographic reporting in videomics research: a review of practices in otolaryngology - head and neck surgery

OBJECTIVE

To assess reporting practices of sociodemographic data in Upper Aerodigestive Tract (UAT) videomics research in Otolaryngology-Head and Neck Surgery (OHNS).

STUDY DESIGN

Narrative review.

METHODS

Four online research databases were searched for peer-reviewed articles on videomics and UAT endoscopy in OHNS, published since January 1, 2017. Title and abstract search, followed by a full-text screening was performed. Dataset audit criteria were determined by the MINIMAR reporting standards for patient demographic characteristics, in addition to gender and author affiliations.

RESULTS

Of the 57 studies that were included, 37% reported any sociodemographic information on their dataset. Among these studies, all reported age, most reported sex (86%), two (10%) reported race, and one (5%) reported ethnicity and socioeconomic status. No studies reported gender. Most studies (84%) included at least one female author, and more than half of the studies (53%) had female first/senior authors, with no significant differences in the rate of sociodemographic reporting in studies with and without female authors (any female author: p = 0.2664; first/senior female author: p > 0.9999). Most studies based in the US reported at least one sociodemographic variable (79%), compared to those in Europe (24%) and in Asia (20%) (p = 0.0012). The rates of sociodemographic reporting in journals of different categories were as follows: clinical OHNS: 44%, clinical non-OHNS: 40%, technical: 42%, interdisciplinary: 10%.

CONCLUSIONS

There is prevalent underreporting of sociodemographic information in OHNS videomics research utilizing UAT endoscopy. Routine reporting of sociodemographic information should be implemented for AI-based research to help minimize algorithmic biases that have been previously demonstrated.

LEVEL OF EVIDENCE: 4

Possible Participation of Adenine Nucleotide Translocase ANT1 in the Cytotoxic Action of Progestins, Glucocorticoids, and Diclofenac on Tumor Cells

A comparative analysis of the cytostatic effects of progestins (gestobutanoyl, megestrol acetate, amol, dienogest, and medroxyprogesterone acetate), glucocorticoids (hydrocortisone, dexamethasone), and diclofenac on tumor cells was carried out in order to confirm their in silico predicted probabilities experimentally. The results showed the different sensitivity of HeLa, MCF-7, Hep-2, K-562, and Wi-38 cell lines to progestins, glucocorticoids, and diclofenac. The minimum IC50 was found for progestin gestobutanoyl (GB) as 18 µM for HeLa cells, and varied from 31 to 38 µM for MCF-7, Hep-2, and K-562. Glucocorticoids and diclofenac were much less cytotoxic in the HeLa, MCF-7, and Hep-2 cell lines than progestins, with IC50 values in the range of 150-3000 μM. Myelogenous leukemia K-562 cells were the least sensitive to the action of progestins and glucocorticoids but the most sensitive to diclofenac, which showed a pronounced cytotoxic effect with an IC50 of 31 μM. As we have shown earlier, progestins can uniquely modulate MPTP opening via the binding of adenine nucleotide translocase. On this basis, we evaluated the expression of adenylate nucleotide translocase ANT1 (SLC25 A4) as a possible participant in cytotoxic action in these cell lines after 48 h incubation with drugs. The results showed that progestins differently regulated ANT1 expression in different cell lines. Gestobutanoyl had the opposite effect on ANT1 expression in the HeLa, K562, and Wi-38 cells compared with the other progestins. It increased the ANT1 expression more than twofold in the HeLa and K562 cells but had no influence on the Wi-38 cells. Glucocorticoids and diclofenac increased ANT1 expression in the Wi-38 cells and decreased it in the K562, MCF-7, and Hep-2 cells. The modulation of ANT1 expression discovered in our study can be a new explanation of the cytotoxic and cytoprotective effects of hormones, which can vary depending on the cell type. ANT isoforms in normal and cancerous cells could be a new target for steroid hormone and anti-inflammatory drug action.

Vocal Fold Thinning in Transgender Patients

PURPOSE

Transgender individuals strive to match their voice and gender identity. An increased glottal gap is often noted on stroboscopy without a clear etiology. We hypothesize this gap can be quantified and results from hormone replacement therapy impacting laryngeal tissues.

METHODS

Videostroboscopy exams were retrospectively collected for transgender patients from a tertiary care laryngology practice over two years. Data included hormone duration/type and voice therapy duration. Modal pitch videostroboscopy frame counts determined the open quotient in consecutive vocal fold cycles. Glottal opening was measured using the widest still frame gap during stroboscopy with fully adducted arytenoids.

RESULTS

Sixteen transgender patients, along with male and female controls, were included, with 15 patients on hormone therapy (mean = 18 months). Voice therapy, employed in 9/16 patients, ranged from 0 to 23 months (mean = 10.67). One-way ANOVA testing revealed a difference between the open quotient in transgender individuals, males, and females.Tukey's post hoc test identified transgender patients as different from both male (P <0.001) and female (P = 0.037) controls. Length of hormone therapy did not correlate to glottal area measurement or open quotient. Conversely, voice therapy length correlated to increased glottal area (Kendall's Tau = 0.03). Mean phonation time, VHI-10, and mean pitch did not correlate to measured glottal area on stroboscopy.

CONCLUSIONS

The increased glottal gap noted in many transgender patients, quantified via the open quotient, differs from male and female controls. Results suggest these findings may correlate to duration of voice therapy.

Voice, Speech, and Clinical Aspects During Pregnancy: A Longitudinal Study

BACKGROUND

Pregnancy involves anatomical, physiological, and metabolic changes in a woman's body. However, the effects of these changes on the voice remains unclear, particularly regarding the clinical characteristics.

OBJECTIVES

We aimed to evaluate changes in vocal and speech acoustic measures and the relationship between them and clinical aspects in women during pregnancy.

METHOD

A prospective, longitudinal study was carried out with 41 low risk, adult, pregnant women, followed for prenatal care. Demographic and anthropometric data as well as lifestyle habits and health conditions were collected. Voice recordings of sustained vowels, and automatic and spontaneous speech were held over each trimester and analyzed by PRAAT®to evaluate acoustic, aerodynamic, and articulatory measures.

RESULTS

There were no changes in fundamental frequency, jitter, shimmer, and harmony to noise ratio during pregnancy. Maximum phonation time (MPT), pause rate, and pause duration reduced at the end of pregnancy. MPT was lower in sedentary pregnant women. The fundamental frequency peak rate was higher in eutrophic participants and lower in the third trimester in women with BMI ≥25 kg/m2. Pause rate was higher in pregnant women with BMI ≥25 kg/m2. There was no relationship between sleep quality, reflux, and vocal symptoms and acoustic and aerodynamic measures.

CONCLUSIONS

Differences were shown in MPT and temporal pause measurements during pregnancy. Acoustic measurements did not change. There was a relationship between acoustic and aerodynamic measures and clinical variables (BMI, physical activity, and body mass gain).

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.

Estrogen receptors and their roles in the immune and respiratory systems

Estrogen is an important hormone for health in both genders. It is indispensable to glucose homeostasis, immune robustness, bone health, cardiovascular health, and neural functions. The main way that estrogen acts in the cells is through estrogen receptors (ERs). The presence of specific estrogen receptors is required for estrogen to have its characteristic ubiquitous action in almost all tissues. Estrogen receptor alpha (ERα) and estrogen receptor beta (ERβ) are the major isoforms of estrogen that are highly specific in humans and enable selective hormonal actions in different tissues. This article reviews some of the observed estrogen actions and effects in different tissues and cells through these specific receptors. This ubiquitous, almost ordinary hormone may reveal itself as a significant factor that helped us to better understand the complexity of the human immune system response against respiratory infections, including the COVID-19, and especially in the current state of this painful pandemic.

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.

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.

Associations of Sex Hormones and Anthropometry with the Speaking Voice Profile in the Adult General Population

OBJECTIVE

There is evidence that sexual hormone concentrations and anthropometric factors influence the human voice. The goal of this study was to investigate to what extent body mass index (BMI), body height, body weight, breast-to-abdomen-ratio, testosterone, estradiol, dehydroepiandrosterone-sulfate (DHEA-S), follicle-stimulating hormone, and luteinizing hormone are associated with the sound pressure level and the fundamental frequency of the speaking voice in a cross-sectional approach among adults in the general population.

METHODS

Speaking voice profiles with four different intensity levels, hormone concentrations, and anthropometric parameters were assessed for 2,381 individuals aged 40-79 years, who were randomly sampled from the population of a large city in Germany. Multivariate analysis was performed, adjusting for age and stratified by sex.

RESULTS

Taller body height was associated with lower frequencies. Higher body weight was associated with lower frequencies and higher sound pressure levels. The ratio of chest to abdominal circumference was associated with the sound pressure levels in males and females: participants with larger breast-to-abdomen-ratio were found to have higher sound pressure levels. Among the sexual hormones, higher concentrations of DHEA-S were associated with lower fundamental frequencies of the voice while using the normal speaking voice. In addition, bioavailable testosterone was associated with the sound pressure level of the normal speaking voice in men and the softest speaking voice in women.

CONCLUSION

Our findings suggest that BMI, body height, body weight, breast-to-abdomen-ratio, bioavailable testosterone, and DHEA-S are associated with the speaking voice in adults. No associations between testosterone and the frequency of the speaking voice were found.

Effect of Pregnancy on Vocal Cord Histology: An Animal Experiment

BACKGROUND

Voice may be affected during the period of pregnancy, especially in the third trimester. However, the exact mechanisms leading to the phonatory changes have not yet uncovered.

AIMS

The aim of this study is to investigate the possible histological changes in the vocal cords of the pregnant rats in three separate trimesters.

STUDY DESIGN

Animal experiment.

METHODS

Twenty-five Wistar-Albino female rats were divided into four groups: control group, pregnancy day 7 (Group 1), pregnancy day 14 (Group 2) and pregnancy day 20 (Group 3). The laryngeal specimens were obtained under general anesthesia. Histological assessment was performed using Hematoxylin-eosin and toluidine blue. A stereological analysis of vocal cord tissue was performed using a NIS-Elements D32 Imaging Software.

RESULTS

Lamina propria was observed to be edematous, and the lamina propria area was thickened starting from the second trimester. Glycosaminoglycans were observed to increase in the second trimester. Although none was encountered in the control, mast cells were observed in the lamina propria layer of the vocal cord starting in the muscular layer in the first trimester proceed to the subepithelial region as degranulated just before term. The covering epithelium remained unchanged throughout pregnancy.

CONCLUSION

Lamina propria thickening may be attributed to both edema and increased glycosaminoglycans. The presence of mast cells in the cordal tissue may induce edema during pregnancy in rats.

The Speaking Voice in the General Population: Normative Data and Associations to Sociodemographic and Lifestyle Factors

OBJECTIVES

Normative data concerning the speaking voice in the general population were gathered with the aim to establish standard values for clinical diagnostics. Associations between the speaking voice and sociodemographic factors were examined.

STUDY DESIGN

This is a prospective cross-sectional population-based study.

METHODS

Speaking voice profiles were measured for 2472 (1154 male and 1318 female) participants between the ages of 40 and 79 years, using four speaking voice intensity levels: softest speaking voice (I), conversational voice (II), classroom voice (III), and shouting voice (IV). Smoking status and socioeconomic status were assessed. Data were analyzed using multivariate regression.

RESULTS

The mean voice frequencies were 111.8 Hz for male and 161.3 Hz for female participants (I), 111.9 Hz for male and 168.5 Hz for female participants (II), 130.2 Hz for male and 198.0 Hz for female participants (III), and 175.5 Hz for male and 246.2 Hz for female participants (IV). Frequencies increased significantly with age for male but not for female participants. Sound pressure levels rose significantly with age at intensity levels I-III for both sexes, but decreased at intensity level IV. Frequencies and sound pressure levels were similar between nonsmokers and former smokers. Current smokers showed significantly lower frequencies as opposed to non- and former smokers. Speaking voice range and dynamics increased with higher socioeconomic status.

CONCLUSIONS

The data are suitable as age-adjusted normative values for clinical measurement of the speaking voice. The mean fundamental speaking voice frequency of female participants was six to seven semitones lower than previously described.

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.

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.

Speech Articulation of Low-Dose Oral Contraceptive Users

OBJECTIVES

In the female life cycle, hormonal fluctuations may result in impaired verbal efficiency and vocal worsening during the premenstrual phase. Oral contraceptives may interfere with vocal range. Voice, resonance, and articulation variations clarify speech content. To investigate the phonoarticulatory sounds produced by oral contraceptive users aged between 20 and 30 years.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Our study included four groups of women (n = 66): two groups used low-dose oral contraceptives and two groups did not use any oral contraceptives. Questionnaires and sound records were used. Acoustic analysis was performed using the Computerized Speech Laboratory program, Model 4341 (Kay Elemetrics Corp, Lincoln Park, New Jersey). The statistical analysis of the SPPS database, version 13.0, was performed by means of generalized estimating equation.

RESULTS

In the groups that did not use oral contraceptives, sustained vowel tones were more acute in the two phases and cycles of women older than 25 years (w/oOC1, 175 ± 74 to 190 ± 55 Hz; w/oOC2, 194 ± 56 to 210 ± 32 Hz). At the midfollicular phase (Fph) and midluteal phase (Lph) of the two cycles, the speed of the speech was slower in this group (w/oOC1: Fph, 5.3 ± 1.6/s and Lph, 5.4 ± 1.4/s; w/oOC2: Fph, 4.5 ± 1.7/s and Lph, 4.8 ± 1.1/s). In both groups that used oral contraceptives, there was a higher modulation frequency in the sentences when compared with nonusers (OC1, 33 ± 10 Hz; w/oOC1, 28 ± 10 Hz; OC2, 34 ± 10 Hz; w/oOC2, 27 ± 10 Hz). Vocal intensity was closer between the OC1 (62 ± 4 dB), w/oOC1 (61 ± 3 dB), and OC2 (63 ± 4 dB) groups when compared with the w/oOC2 (67 ± 6 dB) group.

CONCLUSIONS

We demonstrated hormonal influences on speech articulation of contraceptive users and nonusers.

Parâmetros acústicos de vozes de mulheres na pós-menopausa

INTRODUÇÃO: O envelhecimento da voz caracteriza-se por alterações decorrentes do envelhecimento do corpo, interferindo na entonação vocal reveladora de estados da alma e do corpo. Investigar a qualidade vocal de mulheres na pós-menopausa por meio dos parâmetros objetivos torna-se importante para fomentar as pesquisas nessa área, bem como auxiliar na melhoria da qualidade de vida desse grupo. OBJETIVO: Verificar os valores dos parâmetros acústicos das vozes de mulheres no período de pós-menopausa. Método: Realizou-se estudo de caráter quantitativo e corte transversal com 23 mulheres em período de pós-menopausa, utilizando o software Praat 5.2.0. Os parâmetros considerados foram frequência fundamental, jitter, shimmer, proporção harmônico ruído e análise espectrográfica. A amostra foi composta por mulheres matriculadas numa Universidade Aberta da Terceira Idade em Salvador-BA. A análise dos dados foi descritiva, por porcentagem simples, e usou-se o teste t para verificar a relação entre aumento de idade e piora vocal. RESULTADOS: Apresentaram valores da frequência fundamental abaixo de 150Hz 13% da amostra, e 34% entre 150 e 217Hz, demonstrando agravamento da voz. Observou-se significância estatística para piora desse parâmetro relacionado ao aumento da idade (p=0,02471). Houve diferença quanto aos parâmetros jitter e shimmer de acordo com o aumento da idade, porém sem significância estatística. Esses parâmetros acústicos estão relacionados a alterações no padrão vibratório das pregas vocais (ciclo vibratório). Os valores da proporção harmônico-ruído foram acima de 15.000 para todas as mulheres, mas também foram observados valores diminuídos com o aumento da idade, sem significância estatística. CONCLUSÃO: As alterações nos parâmetros acústicos observadas demonstram que as mulheres na pós-menopausa apresentaram mudanças no padrão vocal, o que pode levar à diminuição da qualidade de vida. Diante disso, necessita-se de um olhar mais atento quanto à necessidade da atuação fonoaudiológica nesse grupo.