Abstract
Arthritis may affect the larynx and produce symptoms such as hoarseness and vocal fatigue. ObjectiveThis paper aimed to evaluate the laryngeal manifestations of rheumatoid arthritis. MethodsThis is prospective study assessed 27 patients with rheumatoid arthritis with the aid of videolaryngostroboscopy, auditory-perceptual analysis of the speech using the GIRBAS scale, acoustic analysis and the Voice Handicap Index questionnaire. ResultsNineteen patients had laryngeal complaints, the main ones being intermittent dysphonia and sensation of a foreign body in the throat. The most frequent laryngoscopical finding was overlapping arytenoids. Three patients had low pitch, nine patients had mild dysphonia and roughness. Median acoustic measures were: F0, 198.39 Hz; Jitter, 0.815; Shimmer, 4.915; and NHR, 0.144. Regarding the Voice Handicap Index, the median score was zero in all domains. There was a statistically significant correlation between voice complaints and the domains of this index. Functional classes were significantly correlated to: overlapping arytenoids (p = 0.001), PPQ (p = 0.0257), Shimmer (p = 0.0295), APQ (p = 0.0195), and the VHI physical (p = 0.0227) and total domains (p = 0.0425). ConclusionLaryngeal complaints were reported by 70.4% of the patients and laryngoscopical alterations were observed in 48% of the subjects. Voice acoustic evaluation and self-perception were altered.
Highlights
Since the paper by Mackenzie, in 18941, rheumatism has been correlated to laryngeal involvement and symptoms such as hoarseness and vocal fatigue, and occasionally severe glottic obstruction
Laryngeal complaints were reported by 70.4% of the patients and laryngoscopical alterations were observed in 48% of the subjects
Our study revealed statistical correlations between voice handicap index (VHI) scores and Rheumatoid arthritis (RA) class, and VHI scores and complaint of dysphonia
Summary
Since the paper by Mackenzie, in 18941, rheumatism has been correlated to laryngeal involvement and symptoms such as hoarseness and vocal fatigue, and occasionally severe glottic obstruction. In this sense, ankylosis of the cricoarytenoid joint (CJ) was believed to be a much more common disease than what is generally supposed[2]. The main mechanism that limits joint function is the unilateral or bilateral fixation of the vocal fold by ankylosis consequent to RA. The following signs have been described: hyperemia and edema of the mucosa covering the CJ; the CJ may become disorganized and the joint ankylosed in a deforming position; and the fixation of one or both vocal folds may occur medially[4]
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