Effect of systemic isotretinoin treatment on voice

Abstract

Objectives: This study aims to investigate the effects of oral systemic Isotretinoin Iso treatment of acne vulgaris, as a chronic inflammatory disease, on voice. Patients and Methods: Between March 2014 and May 2016, a total of 62 volunteer patients 40 females, 22 males; mean age 22.4±5.5 years; range 18 to 36 years with systemic Iso therapy indication due to acne vulgaris were included in the study. Ear nose and throat examination, videolaryngostroboscopy VLS and acoustic voice analysis sound pressure level [SPL], mean F0, first three formants, jitter%, shimmer% and noise to harmonic ratio [NHR] were performed, maximum phonation time MPT and s/z ratio were measured at pretreatment, third and sixth months of treatment and sixth month after the treatment was stopped. The Voice Handicap Index VHI-10 and the GRBAS scales were performed for perceptual voice evaluation. Results: There was no statistically significant difference in MPT, F0, the first three formants, SPL, GRBAS increased during the treatment , shimmer% ratings and VLS parameters during the Iso treatment. Voice Handicap Index-10, s/z ratio, jitter% and NHR were observed to have increased significantly during the treatment. Conclusion: Six-month regular systemic Iso treatment at standard clinical doses has mild negative effects on voice quality and this impact returns to baseline after the treatment is stopped. It is recommended that patients, especially vocal artists, to be informed prior to treatment about this possible side effect.

Keywords

• Dysphonia, isotretinoin, voice

Sistemik isotretinoin kullanımının ses üzerindeki etkisi

Abstract

Amaç: Bu çalışmada kronik bir inflamatuvar hastalık olan akne vulgarisin tedavisinde sistemik Isotretionoin Iso kullanımının ses üzerindeki etkisi araştırıldı.Hastalar ve Yöntemler: Mart 2014 - Mayıs 2016 tarihleri arasında, akne vulgaris nedeniyle sistemik Iso kullanımı endikasyonu olan toplam 62 gönüllü hasta 40 kadın, 22 erkek; ort. yaş 22.4±5.5 yıl; dağılım 18-36 yıl çalışmaya dahil edildi. Tedavi öncesinde, tedavinin üçüncü ve altıncı aylarında ve tedavinin bitiminden altı ay sonra kulak burun boğaz muayenesi, videolaringostroboskopi VLS , akustik ses analizi ses basınç seviyesi [SPL], ortalama F0, ilk üç formant, jitter%, shimmer% ve ses harmoni oranı [NHR] yapıldı, maksimum fonasyon zamanı MPT ve s/z oranı ölçüldü. Algısal ses değerlendirilmesinde Ses Handikap İndeksi-10 VHI-10 ve GRBAS kullanıldı.Bulgular: Maksimum fonasyon zamanı, F0, ilk üç formant, SPL, GRBAS tedavi sırasında artış gösterdi , shimmer% değerlerinde ve VLS parametrelerinde istatistiksel olarak anlamlı bir değişiklik saptanmadı. Ses Handikap İndeksi-10, s/z oranı, jitter% ve NHR’nin tedavi sırasında anlamlı olarak arttığı görüldü.Sonuç: Standart klinik dozda altı aylık düzenli sistemik Iso tedavisinin ses kalitesi üzerinde hafif bir olumsuz etki gösterdiği ve bu etkinin tedavi sonlandırıldığında başlangıçtaki duruma döndüğü saptandı. Hastaların, özellikle de ses sanatçılarının, tedavi öncesinde bu olası yan etki açısından bilgilendirilmeleri önerilir

Keywords

• Disfoni, isotretinoin, ses.

References

1. Lanoue J, Goldenberg G. Acne scarring: a review of cosmetic therapies. Cutis 2015;95:276-81.
2. Ward A, Brogden RN, Heel RC, Speight TM, Avery GS. Isotretinoin. A review of its pharmacological properties and therapeutic efficacy in acne and other skin disorders. Drugs 1984;28:6-37.
3. Layton A. The use of isotretinoin in acne. Dermatoendocrinol 2009;1:162-9.
4. McLane J. Analysis of common side effects of isotretinoin. Analysis of common side effects of isotretinoin. J Am Acad Dermatol 2001;45:188-94.
5. Davis WL, Jacoby BH, Farmer GR, Cooper OJ. Changes in cytosolic calcium, bleb formation, and cell death in neural crest cells treated with isotretinoin and 4-oxo- isotretinoin. J Craniofac Genet Dev Biol 1991;11:105-18.
6. Ahmad HM. Analysis of clinical efficacy, side effects, and laboratory changes among patients with acne vulgaris receiving single versus twice daily dose of oral isotretinoin. Dermatol Ther 2015;28:151-7.
7. Hirano M. Morphological structure of the vocal cord as a vibrator and its variations. Folia Phoniatr (Basel) 1974;26:89-94.
8. Sivasankar M, Leydon C. The role of hydration in vocal fold physiology. Curr Opin Otolaryngol Head Neck Surg 2010;18:171-5.

9. Akdoğan O, Bekiroğlu N, Oztarakçi H. Reliability and validity of the Turkish version of the Voice Handicap Index. Kulak Burun Bogaz Ihtis Derg 2008;18:139-47.
10. Eadie T, Sroka A, Wright DR, Merati A. Does knowledge of medical diagnosis bias auditory-perceptual judgments of dysphonia? J Voice 2011;25:420-9.
11. Dejonckere PH, Bradley P, Clemente P, Cornut G, Crevier-Buchman L, Friedrich G, et al. A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques. Guideline elaborated by the Committee on Phoniatrics of the European Laryngological Society (ELS). Eur Arch Otorhinolaryngol 2001;258:77-82.
12. Leydon C, Sivasankar M, Falciglia DL, Atkins C, Fisher KV. Vocal fold surface hydration: a review. J Voice 2009;23:658-65.
13. Witt RE, Taylor LN, Regner MF, Jiang JJ. Effects of surface dehydration on mucosal wave amplitude and frequency in excised canine larynges. Otolaryngol Head Neck Surg 2011;144:108-13.
14. Finkelhor BK, Titze IR, Durham PL. The effect of viscosity changes in the vocal folds on the range of oscillation. J Voice 1988;1:320-25.
15. Verdolini-Marston K, Titze IR, Druker DG. Changes in phonation threshold pressure with induced conditions of hydration. J Voice 1990;4:142–51.
16. Hemler RJ, Wieneke GH, Lebacq J, Dejonckere PH. Laryngeal mucosa elasticity and viscosity in high and low relative air humidity. Eur Arch Otorhinolaryngol 2001;258:125-9.
17. Arffa RE, Krishna P, Gartner-Schmidt J, Rosen CA. Normative values for the Voice Handicap Index-10. J Voice 2012;26:462-5.
18. Jones SM, Carding PN, Drinnan MJ. Exploring the relationship between severity of dysphonia and voice- related quality of life. Clin Otolaryngol 2006;31:411-7.
19. Li L, Zhang Y, Maytag AL, Jiang JJ. Quantitative Study for the Surface Dehydration of Vocal Folds Based on High-Speed Imaging. J Voice 2015;29:403-9.
20. de Wet F, Weber K, Boves L, Cranen B, Bengio S, Bourlard H. Evaluation of formant-like features on an automatic vowel classification task. J Acoust Soc Am 2004;116:1781-92.
21. Ayache S, Ouaknine M, Dejonkere P, Prindere P, Giovanni A. Experimental study of the effects of surface mucus viscosity on the glottic cycle. J Voice 2004;18:107-15.