title: Voice change in end-stage renal disease patients after hemodialysis: correlation of subjective hoarseness and objective acoustic parameters.
abstract: BACKGROUND
  Patients with end-stage renal disease (ESRD) who are treated with hemodialysis (HD) frequently complain about hoarseness after completion of each HD session. The HD treatment affects laryngeal volume and muscle function. This study attempted to evaluate the vocal effect of HD by acoustic and aerodynamic analysis and to determine the difference between voice change group (VCG) and nonvoice change group (NVCG).
  
  
  METHODS
  A total of 55 patients (34 females and 21 males) diagnosed with ESRD and undergoing outpatient HD were enrolled. The subjects were divided into the VCG (n=13) and NVCG (n=42) by the change of the Korean Voice Handicap Index score. Patients underwent weighing and acoustic, aerodynamic analysis before and after the HD. Fundamental frequency (F0), jitter, shimmer, noise-to-harmonics ratio (NHR), pitch range, habitual pitch, voice energy, and maximal phonation time (MPT) were obtained. The pre- and post-HD data were compared using paired t test. The results were compared after dividing the total group into the VCG and NVCG categories. Correlation between the change of the weight and change of the voice analysis result was certified by Pearson correlation coefficient.
  
  
  RESULTS
  The F0 and habitual pitch increased in all subjects. The NHR and MPT parameters significantly decreased (P<0.05). In the NVCG group, all the results were same as the total group. In the VCG group, the NHR result differed from the total group. All acoustic parameters showed no statistically significant differences between the two groups. There was no correlation between the weight change (%) and the change of acoustic parameter results.
  
  
  CONCLUSIONS
  The NVCG group of patient displayed improvement in NHR, whereas the VCG group showed no change. Weight change did not significantly correlate with the voice analysis results.
authors.affiliation: Department of Otorhinolaryngology-Head & Neck Surgery, School of Medicine, Ewha Womans University, Seoul, Korea.
authors.forename: Soo Yeon
authors.initials: SY
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
authors.forename: Jung-Hwa
authors.initials: JH
authors.lastname: Ryu
authors.affiliation: Department of Otorhinolaryngology-Head & Neck Surgery, School of Medicine, Ewha Womans University, Seoul, Korea.
authors.forename: Hae Sang
authors.initials: HS
authors.lastname: Park
authors.affiliation: Department of Otorhinolaryngology-Head & Neck Surgery, School of Medicine, Ewha Womans University, Seoul, Korea.
authors.forename: Sung Min
authors.initials: SM
authors.lastname: Chung
authors.affiliation: Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
authors.forename: Dong-Ryeol
authors.initials: DR
authors.lastname: Ryu
authors.affiliation: Department of Otorhinolaryngology-Head & Neck Surgery, School of Medicine, Ewha Womans University, Seoul, Korea. Electronic address: sevent@ewha.ac.kr.
authors.forename: Han Su
authors.initials: HS
authors.lastname: Kim
mesh_terms: D000162:Acoustics; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006685:Hoarseness / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D007830:Larynx / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010699:Phonation; D011312:Pressure; D006435:Renal Dialysis / Q000009:adverse effects*; D056910:Republic of Korea; D013018:Sound Spectrography; D013061:Speech Acoustics; D013068:Speech Production Measurement; D013997:Time Factors; D016896:Treatment Outcome; D014833:Voice Quality
keywords: Acoustic analysis; Hemodialysis; Hoarseness