title: Nebulized isotonic saline improves voice production in Sjögren's syndrome.
abstract: OBJECTIVE
  This study examined the effects of a topical vocal fold hydration treatment on voice production over time.
  
  
  METHODS
  Prospective, longitudinal, within-subjects A (baseline), B (treatment), A (withdrawal/reversal), B (treatment) experimental design.
  
  
  METHODS
  Eight individuals with primary Sjögren's syndrome (SS), an autoimmune disease causing laryngeal dryness, completed an 8-week A-B-A-B experiment. Participants performed twice-daily audio recordings of connected speech and sustained vowels and then rated vocal effort, mouth dryness, and throat dryness. Two-week treatment phases introduced twice-daily 9-mL doses of nebulized isotonic saline (0.9% Na(+)Cl(-)). Voice handicap and patient-based measures of SS disease severity were collected before and after each 2-week phase. Connected speech and sustained vowels were analyzed using the Cepstral Spectral Index of Dysphonia (CSID). Acoustic and patient-based ratings during each baseline and treatment phase were analyzed and compared.
  
  
  RESULTS
  Baseline CSID and patient-based ratings were in the mild-to-moderate range. CSID measures of voice severity improved by approximately 20% with nebulized saline treatment and worsened during treatment withdrawal. Posttreatment CSID values fell within the normal-to-mild range. Similar patterns were observed in patient-based ratings of vocal effort and dryness. CSID values and patient-based ratings correlated significantly (P < .05).
  
  
  CONCLUSIONS
  Nebulized isotonic saline improves voice production based on acoustic and patient-based ratings of voice severity. Future work should optimize topical vocal fold hydration treatment formulations, dose, and delivery methodologies for various patient populations. This study lays the groundwork for future topical vocal fold hydration treatment development to manage and possibly prevent dehydration-related voice disorders.
  
  
  METHODS
  2b.
authors.affiliation: Department of Communication Disorders, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A.
authors.forename: Kristine
authors.initials: K
authors.lastname: Tanner
authors.affiliation: Department of Communication Disorders, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A.
authors.forename: Shawn L
authors.initials: SL
authors.lastname: Nissen
authors.affiliation: Department of Health Science, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A.
authors.forename: Ray M
authors.initials: RM
authors.lastname: Merrill
authors.affiliation: Department of Communication Disorders, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A.
authors.forename: Alison
authors.initials: A
authors.lastname: Miner
authors.affiliation: Department of Communication Disorders, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A.
authors.forename: Ron W
authors.initials: RW
authors.lastname: Channell
authors.affiliation: Department of Health Science, Brigham Young University, Provo; the Division of Rheumatology, Salt Lake City, Utah, U.S.A.
authors.forename: Karla L
authors.initials: KL
authors.lastname: Miller
authors.affiliation: Division of Respiratory, Critical Care and Occupational Pulmonary Medicine, Salt Lake City, Utah, U.S.A.|George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Utah, U.S.A.
authors.forename: Mark
authors.initials: M
authors.lastname: Elstad
authors.affiliation: Division of Otolaryngology, Head and Neck Surgery, The University of Utah School of Medicine, Salt Lake City, Utah, U.S.A.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Kendall
authors.affiliation: Department of Communication Sciences and Disorders, The University of Utah, Salt Lake City, Utah, U.S.A.
authors.forename: Nelson
authors.initials: N
authors.lastname: Roy
mesh_terms: D000328:Adult; D000368:Aged; D003681:Dehydration / Q000188:drug therapy; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012859:Sjogren's Syndrome / Q000503:physiopathology* / Q000628:therapy; D012965:Sodium Chloride / Q000008:administration & dosage*; D014827:Vocal Cords / Q000187:drug effects*; D014831:Voice / Q000187:drug effects*
chemical_list: D012965:Sodium Chloride
keywords: CSID; Hydration; Sjögren's Syndrome; nebulized saline; throat dryness; vocal effort; vocal fold surface fluid