Magnetic Resonance Imaging of the Vocal Folds in Women With Congenital Adrenal Hyperplasia and Virilized Voices Purpose Women with congenital adrenal hyperplasia (CAH) may develop a virilized voice due to late diagnosis or suboptimal suppression of adrenal androgens. Changes in the vocal folds due to virilization have not been studied in vivo. The purpose was to investigate if the thyroarytenoid (TA) muscle is affected by virilization ... Research Article
Research Article  |   August 01, 2016
Magnetic Resonance Imaging of the Vocal Folds in Women With Congenital Adrenal Hyperplasia and Virilized Voices
 
Author Affiliations & Notes
  • Ulrika Nygren
    Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Solna, Sweden
    Department of Speech and Language Pathology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
  • Bengt Isberg
    Department of Radiology, Läkarhuset Odenplan, SE-113 22 Stockholm, Sweden
  • Stefan Arver
    Department of Medicine Huddinge, Karolinska Institutet, Solna, Sweden
    Centre for Andrology and Sexual Medicine, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
  • Stellan Hertegård
    Department of Clinical Science, Intervention and Technology, Division of Ear, Nose and Throat Disease, Karolinska Institutet, Solna, Sweden
    Department of Otorhinolaryngology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
  • Maria Södersten
    Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Solna, Sweden
    Department of Speech and Language Pathology, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
  • Agneta Nordenskjöld
    Department of Women's and Children's Health and Center of Molecular Medicine, Karolinska Institutet, Solna, Sweden
    Department of Paediatric Surgery, Astrid Lindgren Children's Hospital, Karolinska University Hospital, SE-141 86 Stockholm, Sweden
  • Disclosure: The authors have declared that no competing interests existed at the time of publication.
    Disclosure: The authors have declared that no competing interests existed at the time of publication. ×
  • Correspondence to Ulrika Nygren: ulrika.nygren@ki.se
  • Editor: Jody Kreiman
    Editor: Jody Kreiman×
  • Associate Editor: Bruce Gerratt
    Associate Editor: Bruce Gerratt×
Article Information
Special Populations / Genetic & Congenital Disorders / Speech, Voice & Prosody / Speech / Research Articles
Research Article   |   August 01, 2016
Magnetic Resonance Imaging of the Vocal Folds in Women With Congenital Adrenal Hyperplasia and Virilized Voices
Journal of Speech, Language, and Hearing Research, August 2016, Vol. 59, 713-721. doi:10.1044/2016_JSLHR-S-14-0191
History: Received July 10, 2014 , Revised January 9, 2015 , Accepted January 8, 2016
 
Journal of Speech, Language, and Hearing Research, August 2016, Vol. 59, 713-721. doi:10.1044/2016_JSLHR-S-14-0191
History: Received July 10, 2014; Revised January 9, 2015; Accepted January 8, 2016
Web of Science® Times Cited: 1

Purpose Women with congenital adrenal hyperplasia (CAH) may develop a virilized voice due to late diagnosis or suboptimal suppression of adrenal androgens. Changes in the vocal folds due to virilization have not been studied in vivo. The purpose was to investigate if the thyroarytenoid (TA) muscle is affected by virilization and correlate findings to fundamental frequency (F0).

Method A case-control study using magnetic resonance imaging and voice recordings. Four women with CAH with virilized voices (26–40 years), and 5 female and 4 male controls participated. Measurements of cross-sectional TA muscle area, vocal fold length, vocal tract length, and acoustic analyses of F0 were performed.

Results Women with CAH had larger cross-sectional TA muscle area than female control subjects and smaller than male controls. A significant negative correlation was found between TA muscle area and mean F0. The patients had a smaller physiological voice range than both female and male controls.

Conclusion Data from our small study suggest that a larger TA muscle area is strongly associated with a lower F0 and thus the anatomical explanation for a female virilized voice, suggesting an androgen effect on the vocal folds. The findings from the present study need to be confirmed in a larger study.

Acknowledgments
This study was supported by grants from the Swedish Research Council (grant number K2012-64X-14506-10-5 to Agneta Nordenskjöld), the Aina Börjeson Foundation for Speech Language Pathology Research and Treatment, Foundation Frimurare Barnhuset, and the Stockholm City Council (grant number 20120013 to Agneta Nordenskjöld). We thank all subjects for taking time for this study and several persons at Karolinska Institutet: Kerstin Hagenfeldt for valuable comments on the study design and article, Elisabeth Berg and Per Östberg for statistics support, Britta Hammarberg for translating an article in German, Gunnar Björck and Per-Åke Lindestad for laryngoscopic examination and/or analysis, and Svante Granqvist for valuable support during finalizing the article. Thanks also to Janet Holmén for language revision, the subjects in the pilot MR study, Mansour Haghgou for making the MRI examinations, and all medical staff at Department of Radiology, Läkarhuset Odenplan in Stockholm for support during analyses.
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