Assessment of the impact of ACE inhibitor-containing medications on the vocal cords through narrow band imaging, videolaryngostroboscopy, and acoustic voice analysis

Objective: Dysphonia is a common symptom encountered in otorhinolaryngology practice and may arise from a variety of etiologies, including infectious, structural, drug-induced, and neurological causes. The primary aim of this study is to investigate the effects of ACE inhibitors—known to cause laryngeal irritation—on voice using both objective and subjective parameters. Material and Method: After receiving ethical approval, the study was prospectively conducted with 37 patients who were prescribed ACE inhibitors at the Cerrahpaşa Medical Faculty's Internal Medicine and Cardiology outpatient clinics. A control group of 32 healthy volunteers was also included. All procedures followed the Declaration of Helsinki. The study group underwent laryngological examinations and voice analyses before starting the medication, on day 1, and on day 30 of use. Similar assessments were performed on the control group. Data from different time points were compared within the study group and with the control group. Results: In pre-medication assessments within the study group, significant differences in voice parameters were observed compared to the control group, suggesting that hypertension and proteinuria, which are indications for ACE inhibitors, may influence the voice. During medication use, a significant reduction in the S/Z ratio and an increase in the total VLS score were noted, while no changes were observed in other parameters. When the VLS parameters were individually evaluated, increases were observed in mucosal wave, amplitude, phase symmetry, periodicity, and compensatory muscle activity; however, no significant changes were detected in the associated acoustic voice analysis parameters, namely jitter, shimmer, NHR, SPI, APQ, vAm, and DUV. Conclusion: ACE inhibitors can cause mucosal changes in the vocal cords and affect phonatory mechanisms without inducing cough, yet they do not lead to significant deterioration in voice analysis. Keywords: ACE inhibitor, voice analysis, MDVP, videolaryngostroboscopy