Abstract
Objective
The aim of the present study was to describe the vocal characteristics of patients with thyroiditis in a clinical setting.
Materials and methods
A total of 17 consecutive patients with the diagnosis of thyroiditis presenting to the endocrinology clinic were invited to participate in the study. A group of 29 healthy subjects were used as controls. They underwent acoustic analysis and a perceptual evaluation using the GRABS classification. The mean score of each parameter was computed, and the distribution of severity of each perceptual parameter were listed.
Results
There was no significant difference in any of the acoustic parameters between the patients and the controls, and there was no significant difference in the mean score of all the perceptual parameters between the patients and the controls. Even when examining the distribution of the severity of evaluation, there was no significant difference between the patients and the controls, as well.
Conclusion
Patients with thyroiditis do not have abnormal perceptual vocal evaluation or acoustic findings compared with controls.
1
Introduction
The thyroid gland can be affected by a spectrum of diseases disrupting its function. These could be infective diseases as in viral and bacterial thyroiditis or inflammatory processes as in autoimmune thyroiditis . In the chronic form, patients may present with signs and symptoms of hypothyroidism as a result of the destruction of the hormone-producing cells by the chronic inflammatory process. The depletion of the secretory function of the gland leads to symptoms of weight loss and glandular hyperplasia with secondary neck disfigurement. In the acute form, the clinical picture of thyrotoxicosis may prevail with nausea, vomiting, and severe palpitations that can be life threatening. In the subacute form, patients may present with thyroidal pain, fever, and neck tenderness .
In all forms of thyroiditis, the most often reported neck symptoms are related either to swallowing or to phonation. Many cases of thyroiditis presenting with symptoms and signs related to the upper aerodigestive system have been reported. With respect to phonation, most reports discuss the phonatory symptoms in the context of thyroidectomies and or injury to the recurrent laryngeal nerve . Based on a literature review, the authors of this study could not identify any study describing the vocal characteristics of patients with thyroiditis not presenting to the emergency department or admitted to the hospital for surgery. By vocal characteristics, we mean vocal perceptual evaluation and acoustic analysis not only the description of vocal symptoms.
The purpose of this study was is to describe the vocal characteristics of patients with thyroiditis in a clinical setting. All patients diagnosed as having thyroiditis presenting to the endocrinology clinic were enrolled in this investigation for a rated perceptual evaluation and an acoustic analysis.
2
Materials and methods
A total of 17 consecutive patients with the diagnosis of thyroiditis presenting to the endocrinology clinic were invited to participate in the study after having read the informed consent approved by the institution review board. These included both subacute and chronic cases. The diagnosis of subacute thyroiditis was based on the presence of fever and neck tenderness, elevated erythrocyte sedimentation rate and C-reactive protein, and a decrease in thyroid radioactive iodine uptake. The chronic cases of thyroiditis were cases of Hashimoto disease. The study took place at the “Hamdan Voice Unit.” Exclusion criteria included history of upper respiratory tract infection or laryngeal surgery, or history of surgery or laryngeal manipulation such as microlaryngeal surgery or direct laryngoscopy. A control group of 29 healthy subjects matched according to age were recruited. Demographic data included age, sex, smoking, allergy, reflux, disease duration, thyroid stimulating hormonal level, and type of disease (as subacute or chronic). Allergy was determined using a validated questionnaire , and laryngopharyngeal reflux was determined using the Belafsky reflux symptom index . For the thyroid-stimulating hormonal level, a range between 0.27 and 4.20 μ U/mL was considered the reference range. The authors made sure that the prevalence of allergy, smoking, and reflux was similar in both groups, those with diseases and the controls, in view of their confounding effect ( Table 1 ).
| Patients (n = 17) | Controls (n = 29) | |
|---|---|---|
| Age (y), mean ± SD | 47.76 ± 12.23 | 39.97 ± 13.42 |
| Sex | ||
| Male | 7 (41.2%) | 16 (55.2%) |
| Female | 10 (58.8%) | 13 (44.8%) |
| Reflux | ||
| No | 15 (88.2%) | 25 (86.2%) |
| Yes | 2 (11.8%) | 4 (13.8%) |
| Allergies | ||
| Absent | 15 (88.2%) | 26 (89.7%) |
| Present | 2 (11.8%) | 3 (10.3%) |
| Smoking | ||
| No | 11 (64.7%) | 20 (69.0%) |
| Yes | 6 (35.3%) | 9 (31.0%) |
| Disease duration (y) | NA | |
| <5 | 15 (88.2%) | |
| 5-10 | 1 (5.9%) | |
| >10 | 1 (5.9%) | |
| TSH | NA | |
| Hyperthyroid | 3 (17.6%) | |
| Euthyroid | 12 (70.6%) | |
| Hypothyroid | 2 (11.8%) | |
| Types of thyroiditis | ||
| Subacute | 14 (88.2%) | |
| Hashimoto | 2 (11.8%) |
All subjects underwent an acoustic analysis using the VISI-PITCH IV by Kay Pentax (Montvale, NJ, USA). The subjects were seated in a quiet room with a microphone placed 10 cm away from the mouth. The patients were asked to phonate the vowel /a/ at a modal pitch and comfortable loudness. The following acoustic parameters were examined: fundamental frequency, shimmer, relative average perturbation, noise to harmonic ratio, and voice turbulence index. The patients were then asked to take a deep breath and phonate for as long as they can, and the maximum phonation time was recorded. Then, they were asked to count to 10, and the habitual pitch was measured. Later on, the recording of the patients was evaluated blindly by the first author and one of the coauthors to rate perceptually the overall grading of the voice, roughness, asthenia, breathiness, and straining. The authors made sure that there was a consensus on the rating of the perceptual measures before adopting any rating. The evaluation was made by both the author and coauthor at the same setting to ensure proper congruence and coherence in the rating. Zero was considered normal; 1, as mild deviation from normal; 2, as moderate deviation from normal; and 3, as severe deviation from normal. The mean score of each parameter was computed, and the distribution of severity of each perceptual parameter was listed.
Frequencies and means (±SDs) were used to describe categorical and continuous variables, respectively. At the bivariate level, the patients and controls were compared using the independent t test to evaluate differences in the mean scores of each acoustic variable. On the other hand, the Wilcoxon–Mann and Whitney rank sum test was used for the comparison of the means of GRABS scores (perceptual evaluation) where normal distribution was not assumed. Pearson χ 2 test was applied for GRABS scores when analyzed in categories, trying to determine if there exists any association between the patients and the controls and their specific GRABS being normal, mild, or moderate. All analyses were conducted using the Statistical Package for the Social Sciences version 17 software package (SPSS, Chicago, IL). A 2-tailed P value of less than .05 was considered statistically significant.
2.1
Demographic data
The mean age of the patients was 47.76 ± 12.23 years, with a female-to-male ratio of 3:2. Eighty-eight percent had a disease duration less than 5 years, and 70.6% had euthyroid. Fifteen of the 17 patients had subacute thyroiditis. The prevalence of allergy, reflux, and smoking was comparable in both the diseased group and the controls. See Table 1 .
2.2
Acoustic analysis
There was no significant difference in any of the acoustic parameters between the patients and the controls. See Table 2 .
| Patients, mean ± SD | Controls, mean ± SD | P | |
|---|---|---|---|
| Fundamental frequency (Hz) | 159.84 ± 42.22 | 153.58 ± 46.27 | .650 |
| Male | 117.09 ± 7.79 | 121.98 ± 24.12 | .820 |
| Female | 189.75 ± 26.70 | 192.47 ± 36.04 | .784 |
| Habitual pitch (Hz) | 150.09 ± 31.43 | 145.91 ± 45.15 | .714 |
| Male | 119.78 ± 10.72 | 116.52 ± 26.78 | .308 |
| Female | 171.30 ± 21.58 | 182.08 ± 35.91 | .232 |
| Jitter (RAP) (%) | 0.81 ± 0.44 | 0.75 ± 0.49 | .687 |
| Shimmer (%) | 3.31 ± 1.40 | 3.54 ± 2.08 | .695 |
| Noise-to-harmonic ratio | 0.12 ± 0.02 | 0.13 ± 0.03 | .236 |
| Voice turbulence index | 0.03 ± 0.01 | 0.04 ± 0.01 | .289 |
| Maximum phonation time (s) | 15.05 ± 5.71 | 15.01 ± 5.59 | .980 |
2.3
Perceptual evaluation
There was no significant difference in the mean score of all the perceptual parameters between the patients and the controls. Even when examining the distribution of the severity of evaluation, there was no significant difference between the patients and the controls, as well. See Tables 3 and 4 .
| Patients, mean ± SD | Controls, mean ± SD | P | |
|---|---|---|---|
| Grade | 0.59 ± 0.51 | 0.48 ± 0.51 | .494 |
| Roughness | 0.65 ± 0.61 | 0.52 ± 0.51 | .515 |
| Asthenia | 0.18 ± 0.39 | 0.28 ± 0.53 | .578 |
| Breathiness | 0.35 ± 0.49 | 0.31 ± 0.47 | .769 |
| Strain | 0.24 ± 0.44 | 0.24 ± 0.51 | .874 |
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
