Voice Changes of Patients With Nasopharyngeal Carcinoma in Eleven Years After Radiotherapy: A Cross-Sectional Study

Cui He; Yixin Chen; Libing Guo; Mingfen Zheng; Jian Wan; Suxiao Fan; Xuhui Zhang; Zeyi Deng; Xiangdong Zhao; Shengsong Yin; Xueman Zhao; Hong Peng; Xiangjun Fu; Ping Xiao

doi:10.1016/j.jvoice.2024.04.017

Voice Changes of Patients With Nasopharyngeal Carcinoma in Eleven Years After Radiotherapy: A Cross-Sectional Study

J Voice. 2024 May 21:S0892-1997(24)00136-X. doi: 10.1016/j.jvoice.2024.04.017. Online ahead of print.

Authors

Cui He¹, Yixin Chen², Libing Guo³, Mingfen Zheng⁴, Jian Wan⁴, Suxiao Fan⁴, Xuhui Zhang³, Zeyi Deng⁴, Xiangdong Zhao⁴, Shengsong Yin³, Xueman Zhao⁴, Hong Peng⁴, Xiangjun Fu⁴, Ping Xiao⁴

Affiliations

¹ Department of Otolaryngology Head and Neck Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, Guangdong Province, China. Electronic address: hellojennyhe@126.com.
² Hearing and Speech Science Department, Guangzhou Xinhua University, Guangzhou City, Guangdong Province, China.
³ Department of Oncology, Guangdong Second Provincial General Hospital, Guangzhou City, Guangdong Province, China.
⁴ Department of Otolaryngology Head and Neck Surgery, Guangdong Second Provincial General Hospital, Guangzhou City, Guangdong Province, China.

PMID: 38772832
DOI: 10.1016/j.jvoice.2024.04.017

Abstract

Objectives: The objective of this study was to assess voice changes in patients with nasopharyngeal carcinoma (NPC) using subjective and objective assessment tools and to make inferences regarding the underlying pathological causes for different phases of radiotherapy (RT).

Methods: A total of 187 (123 males and 64 females) patients with post-RT NPC with no recurrence of malignancy or other voice diseases and 17 (11 males and 6 females) healthy individuals were included in this study. The patients were equally divided into 11 groups according to the number of years after RT. The acoustic analyses, GRBAS (grade, roughness, breathiness, asthenia, and strain) scales, and Voice Handicap Index (VHI)-10 scores were collected and analyzed.

Results: The fundamental frequency (F0) parameters in years 1 and 2 and year 11 were significantly lower in patients with NPC than in healthy individuals. The maximum phonation times in years 1 and 11 were significantly shorter than those in healthy individuals. The jitter parameters were significantly different between year 1 and from years 8 to 11 and the healthy individuals. The shimmer parameters were significantly different between years 1, from years 9 to 11, and healthy individuals. Hoarseness was the most prominent problem compared to other items of the GRBAS. The VHI-10 scores were significantly different between years 1 and 2 and year 11 after RT in patients with NPC.

Conclusions: Voice quality was worse in the first 2 years and from years 8 to 11 but remained relatively normal from years 3 to 7 after RT. Patient-reported voice handicaps began during year 3 after RT. The most prominent problem was perceived hoarseness, which was evident in the first 2 years and from years 9 to 11 after RT. The radiation-induced mucous edema, laryngeal intrinsic muscle fibrosis, nerve injuries, upper respiratory tract changes, and decreased lung capacity might be the pathological reasons for voice changes in post-RT patients with NPC.

Keywords: Nasopharyngeal carcinoma; Radiation injury; Radiotherapy; Voice quality.