Evaluating the effects of smoking on the voice and subjective voice problems using a meta-analysis approach

Abstract

The objectives of this study were to identify the effects of smoking on the voice of smokers and present the baseline data for establishing the basis for preventing voice disorders. This study was evaluated using a meta-analysis from studies published between Jan 1, 2000, and Nov 15, 2018. As a result, the final meta-analysis was conducted using nine papers. The standard mean difference was analyzed after dividing the effects of smoking on voice into the pitch (F0), sound quality (jitter, shimmer, and noise to harmonic ratio; NHR), Maximum Phonation Time (MPT), and subjective voice problem. The results showed that there was a significant difference in F0 and MPT. On the other hand, the jitter, shimmer, NHR, and Voice Handicap Index (VHI) had different mean effect size but they were not significantly different. The analysis by sub-function of VHI results showed that the mean effect size was significantly different only in VHI-P (Physical). This study evaluated the effects of smoking on voice using metaanalysis. It was confirmed that smoking had significant and moderate effects on the F0 of voice, MPT, VHI, and physical functions. It is necessary for future meta-analysis studies to conduct randomized controlled experiments or longitudinal studies to confirm the effect sizes of variables.The physiology of healthy voice production it is affected by a range of factors such as the strength, quality, soundness, and fluidity of sound 1 . However, the changes in the anatomical structure of the larynx can cause functional problems and, as a result, it can negatively affect the voice production to result in voice disorders. It is widely known that voice disorder has a very high reoccurrence rate. A Lyberg-Åhlander et al. 2 evaluated the voice disorders in Sweden and reported that 16.9% of adults (≥18 years old) experienced a voice disorder. Moreover, it was found that 21.9% of adults in the US also experienced a voice disorder in their lifetime 3 . Also, 73.3% of them suffered from the voice disorder multiple times 3 . Particularly, even if voice rehabilitation (e.g., vocal hygiene) is performed after the occurrence of a voice disorder, the risk of a voice disorder reoccurrence is even higher unless the risk factor negatively affecting voice is removed. Although many studies have identified a relationship between chronic smoking and laryngeal pathology, there is still insufficient evidence of the effects of smoking on voice.Previous studies on the effects of smoking on voice health can be divided into three major groups. First, smoking has been reported as a representative risk factor of voice health 4 . For example, smoking can cause a g laryngeal disease 5 . Previous studies evaluating the effects of smoking on the larynx using rats and pigs showed that smoking directly caused the anatomical changes of the larynx 6,7 . Moreover, smokers had a higher risk to have a laryngeal disease than non-smokers 4,5 . It was also confirmed that persisted smoking could cause a vocal cord disease such as laryngitis, Rheinke's edema, and ...

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