Phonatory Effects of Body Fluid Removal Adequate body and vocal fold hydration are believed to be critical to phonation. We hypothesized that body fluid reduction, without dehydration, would increase phonation threshold pressure (Pth) and be associated with patient-perceived increases in phonatory effort and worsening voice quality. Using a single-subject, full-reversal design, a controlled volume of body ... Research Article
Research Article  |   April 01, 2001
Phonatory Effects of Body Fluid Removal
 
Author Affiliations & Notes
  • Kimberly V. Fisher
    Department of Communication Sciences and Disorders Northwestern University Evanston, IL
  • Jack Ligon
    Department of Communication Sciences and Disorders University of Oklahoma Health Sciences Center Oklahoma City
  • Jana L. Sobecks
    Department of Communication Sciences and Disorders Northwestern University Evanston, IL
  • David M. Roxe
    Division of Nephrology/Hypertension Northwestern University Medical School Chicago, IL
Article Information
Speech, Voice & Prosody / Speech / Research Articles
Research Article   |   April 01, 2001
Phonatory Effects of Body Fluid Removal
Journal of Speech, Language, and Hearing Research, April 2001, Vol. 44, 354-367. doi:10.1044/1092-4388(2001/029)
History: Received February 23, 2000 , Accepted October 11, 2000
 
Journal of Speech, Language, and Hearing Research, April 2001, Vol. 44, 354-367. doi:10.1044/1092-4388(2001/029)
History: Received February 23, 2000; Accepted October 11, 2000
Web of Science® Times Cited: 53

Adequate body and vocal fold hydration are believed to be critical to phonation. We hypothesized that body fluid reduction, without dehydration, would increase phonation threshold pressure (Pth) and be associated with patient-perceived increases in phonatory effort and worsening voice quality. Using a single-subject, full-reversal design, a controlled volume of body fluid was repeatedly removed via ultrafiltration from adults with end stage renal disease (2 women, 4 men, ages 40–85 yrs). Two additional men (ages 81 and 68 yrs) served as placebo and healthy true controls, respectively. Pth, vocal effort and quality, blood pressure, and heart rate were assessed longitudinally. Pth increased significantly with fluid volume reduction (3–4% of body weight from a hypervolemic to a grossly normovolemic body state) and reversed to baseline with fluid replacement in 4 of 6 treated subjects. Effects were observed with net ultrafiltration rates greater than or equal to 1.0 L/h; these effects were not observed in control subjects. Fluid loss accounted for 31.6% of variance in Pth and 40.0% of variance in perceived vocal effort. Heart rate, systolic blood pressure, and/or diastolic blood pressure were significantly correlated with Pth or fluid volume reduction in 6 subjects, including the placebo control (–.70 ≤ r≤–.44). Results indicate that substantial extracellular volume depletion without body dehydration causes voice symptoms, an effect possibly mediated by autonomic nervous control. We propose that mechanisms intrinsic to the vocal fold regulate its water flux and respond to hydration challenges.

Acknowledgments
This work was supported in part by grant number 1K08DC00168 from the National Institute on Deafness and Other Communication Disorders. We are indebted to Donovan Yeates for many fruitful discussions about airway water transport and to Charles Larson, Ingo Titze, and Katherine Verdolini for generous comments about an earlier version of this manuscript. We also benefited from the observations of seminar students Cheryl Giddens, Sabina Sood, Tamara Motel, Preeti Sivasankar, Eihab Alwawei, and Ali Sepahdari.
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