Objective and subjective evaluation of voice in hereditary angioedema patient group

Objective: It was aimed to examine the effects of hereditary angioedema on the voice in the chronic period. Method: 31 patients with hereditary angioedema followed in the Adult Immunology and Allergy Diseases outpatient clinic of Necmettin Erbakan University (NEU) Meram Medical Faculty and 25 healthy individuals with similar age and gender distribution without any additional disease were included in the study as the control group. Smokers, patients with gastroesophageal reflux disease, voice disease, history of laryngeal surgery and pathology that may affect the voice in the oral cavity, oropharynx, nasopharynx or larynx were excluded from the study. Voice handicap index questionnaire, voice-related quality of life scale and reflux symptom index questionnaires were administered to all patients and the control group. All video endoscopy recordings were made with a 5.8 mm diameter, 19 cm long and 70º angled rigid Hopkins rod telescope (Karl Storz, Tuttlingen, Germany) and were recorded with an endoscopic camera system (Karl Storz TELE PACK Endovision System). The patients were not exposed to trauma during the procedure. Sound recording and acoustic analyzes were performed in an isolated room free from environmental noise. Recordings were obtained using an Audio-Technica model AT2005 dynamic microphone (AudioTechnica Productions, Western Hemisphere) at a fixed mouth-to-mouth distance of 15 cm. The patients were asked to pronounce the vowel 'a' for 7 seconds. All acoustic measurements were made using Praat computer software. Fundamental frequency (F0), formant frequency (F1, F2, F3 and F4), frequency perturbation (jitter), amplitude perturbation (shimmer) and Noise-Harmonic Ratio (NHR) parameters were evaluated in acoustic sound analysis of all patients. Results: 61.30% (n=19) of the patient group and 60.00% (n=15) of the control group were women. The mean age of the patients was 41.19±12.82 years, and the control group was 40.08±8.99 years. While the body mass index (BMI) of the patient group was 28.43±6.41 kg/m2, it was 28.95±2.62 kg/m2 in the control group. Gender, age and BMI distributions were found to be statistically similar between the patient and control groups. 67.70% (n=21) of the patients were in the Type 1 and 32.30% (n=10) Type 2 hereditary angioedema group. It was noted that laryngeal symptoms such as shortness of breath, difficulty in swallowing, hoarseness, and a feeling of fullness in the throat were observed in 61.30% (n=19) of the patients. The mean number of laryngeal attacks of the patients was determined as 6.68±11.94. Patient VHI, Patient VQI and patient reflux values were statistically significantly higher in the patient group than in the control group (p values, respectively; p=0.007; p=0.001; p<0.001). The distribution of other acoustic parameters between the patient and control groups was similar (p>0.05). . The patient's reflux value was found to be statistically higher in the group with 5 or more attacks. (p=0.018). Conclusion: In our study, it was shown that reflux is observed more frequently in hereditary angioedema, but in the chronic period, hereditary angioedema does not have a permanent effect on objective vocal parameters. It was observed that reflux complaints increased as the number of attacks increased.