Citation Information :
Joshi AA, Dhorje NR, Bradoo RA, Rupwate K, Arora DS. Assessing the Short-term Effects of Endotracheal Intubation on Voice Change and Acoustic Parameters: A Prospective Observational Study. Int J Phonosurg Laryngol 2021; 11 (1):21-24.
Aims and objectives: (1) To examine vocal symptoms and acoustic changes perceived within 24 hours after endotracheal intubation and (2) to find the association between these changes and endotracheal tube (ET) parameters and determine which parameter affects voice the most.
Materials and methods: A prospective analysis of 75 patients was done. They were examined preoperatively, and 2 and 24 hours postoperatively. The vocal symptoms of hoarseness, vocal fatigue, loss of voice, throat clearing (hawking), globus pharyngeus, throat pain, and the acoustic variables mainly average fundamental frequency, shimmer, harmonic noise ratio (HNR), and maximum phonation time (MPT) were assessed. The ET parameters considered were duration of anesthesia, number of attempts at intubation, size of the tube, ET cuff volume, and mean cuff pressure.
Results: Approximately 60% of patients with cuff volume above 3 cm3 and 80% of patients with more than two intubation attempts developed postoperative vocal fatigue, while 70% with mean cuff pressure above 20 cm of water developed postoperative hawking.
Conclusion: The ET parameters, mean cuff pressure, and ET cuff volume are the most important variables that are associated with the increase in vocal symptoms. An increase in the value of these parameters is associated with more postoperative discomfort.
McGovern FH, Fitz-Hugh GS, Edgemon LJ. The hazards of endotracheal intubation. Ann Otol, Rhinol Laryngol 1981;80(4):556. DOI: 10.1177/000348947108000419.
Hedden M, Ersoz CJ, Donnelly HW, et al. Laryngotracheal damage after prolonged use of orotracheal tubes in adults. JAMA Otolaryngol 1977;207:703.
Weymuller E, Bishop M. Problems associated with prolonged intubation in the geriatric patient. Otolaryngolog Clin N Am 1990;23(6):1057–1074. DOI: 10.1016/S0030-6665(20)31189-0.
Huang H-H, Lee M-S, Shih Y-L, et al. Modified mallampati classification as a clinical predictor of peroral esophagogastroduodenoscopy tolerance. BMC Gastroenterol 2011;11(1):12. DOI: 10.1186/1471-230X-11-12.
Hamdan AL, Sibai A, Rameh C, et al. Short-term effects of endotracheal intubation on voice. J Voice Elsevier 2007;21(6):762–768. DOI: 10.1016/j.jvoice.2006.06.003.
Beckford NS, Mayo R, Wilkinson III A, et al. Effects of short endotracheal intubation on vocal function. Laryngoscope 1990;100(4):331–336. DOI: 10.1288/00005537-199004000-00001.
Finkelhor BK, Titze IR, Durham PL. The effect of viscosity changes in the vocal folds on the range of oscillation. J Voice 1988;1(4):320–325. DOI: 10.1016/S0892-1997(88)80005-5.
Bless D, Shaikh A, The effect of atropine on voice production. Presented at: State Medical Society of Otolaryngology, Milwaukee, WI, 1986.
Alessi D, Hanson D, Berci G. Bedside videolaryngoscopic assessment of intubation trauma. Ann Otol, Rhinol Laryngol 1989;98(8):586–590. DOI: 10.1177/000348948909800803.
Preschel U, Eysholdt U. Kurzzeit-Veranderungen an Kehlkopf und Stimme nach Intubation. Laryngol Rhinol Otol (Stuttg) 1993;72(93):7. DOI: 10.1055/s-2007-997863.
Bishop M. Mechanisms of laryngotracheal injury following prolonged tracheal intubation. Chest 1989;96(1):185–186. DOI: 10.1378/chest.96.1.185.
Colice G, Stukel T, Dain B. Laryngeal complications of prolonged intubation. Chest 1989;96(4):877–884. DOI: 10.1378/chest.96.4.877.
Weymuller E, Bishop M, Fink B, et al. Quantification of intralaryngeal pressure exerted by endotracheal tubes. Ann Otol, Rhinol Laryngol 1983;92(5):444–447. DOI: 10.1177/000348948309200506.
Weymuller E. Laryngeal injury from prolonged endotracheal intubation. Laryngoscope 1988;98(suppl 45):1–15. DOI: 10.1288/00005537-198808001-00001.
Leonard R, Senders C, Charpied G. Effects of long term intubation on vocal fold mucosa in dogs. J Voice 1992;6(1):86–93. DOI: 10.1016/S0892-1997(05)80012-8.
Horii Y, Fuller B. Selected acoustic characteristics of voices before intubation and after extubation. J Speech Lang Hear Res 1990;33(3):505–510. DOI: 10.1044/jshr.3303.505.
Gleeson MJ, Fourcin AJ. Clinical analysis of laryngeal trauma secondary to intubation. J Royal Soc Med 1983;76(11):928. DOI: 10.1177/014107688307601108.
Yonick T, Reich A, Minifie F, et al. Acoustical effects of endotracheal intubation. J Speech Hear Disord 1990;55(3):427–433. DOI: 10.1044/jshd.5503.427.