Voice alterations in patients with Morquio A syndrome

J Appl Genet. 2018 Feb;59(1):73-80. doi: 10.1007/s13353-017-0421-6. Epub 2017 Dec 23.


Morquio A syndrome, or mucopolysaccharidosis (MPS IV A), is an inherited lysosomal storage disorder which belongs to the group of mucopolysaccharidoses (MPSs). It is caused by N-acetylgalactosamine-6-sulfatase (GALNS) activity deficiency, which results in impaired degradation of glycosaminoglycans (GAGs), including keratan sulfate (KS) and chondroitin-6-sulfate (CS). These compounds infiltrate and disrupt the architecture of the extracellular matrix, compromising the integrity of the connective tissue. Patients with Morquio A have also been noted for exhibiting abnormalities of the larynx and vocal tract. The aim of the study was to assess voice alterations using noninvasive acoustic and electroglottographic voice analysis. Electroglottographic signal and acoustic analyses revealed considerable changes in the voices of patients with Morquio A syndrome when compared to the voices of healthy controls. Affected patients tended toward tense voice, incomplete glottal closure, increased incidence of vocal fold nodules, dysphonia, and hoarse voice. Morquio A syndrome is characterized by connective tissue disease, which adversely affects voice quality. The use of objective voice analysis makes it possible to quantitatively monitor changes in the vocal apparatus over the course of disease progression, and also allows for assessment of the effects of the enzyme replacement therapy.

Keywords: Genetic disorder, electroglottography; Metabolic disorders; Morquio a syndrome; Vocal folds; Voice and speech disorder, voice quality.

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Child, Preschool
  • Chondroitinsulfatases / deficiency
  • Female
  • Humans
  • Male
  • Mucopolysaccharidoses / complications*
  • Mucopolysaccharidoses / physiopathology
  • Mucopolysaccharidosis IV / complications*
  • Mucopolysaccharidosis IV / physiopathology
  • Speech Acoustics
  • Voice Disorders / etiology*
  • Voice Quality*


  • Chondroitinsulfatases