title: Anticholinergic Use Is a Major Risk Factor for Dysphonia.
abstract: OBJECTIVE
  We hypothesize that many cases of dysphonia of unclear etiology are a form of sicca caused by anticholinergic medication use, and we aim to determine their association.
  
  
  METHODS
  This was a cross-sectional study conducted over a 6-month time period. Participants were drawn from a tertiary care laryngology practice within an academic institution.
  
  
  METHODS
  One hundred forty-nine patients met inclusion criteria. Patients rated the symptom of chronic hoarseness; scores were compared with participants' medication lists, comorbidities, age, and sex, and a multivariate logistic regression model was developed. Significance was set at P<.05. As a secondary analysis, participants rated a variety of other symptoms using the Voice Handicap Index-10, Reflux Symptom Index, and the GRBAS scale, which were likewise compared to anticholinergic use.
  
  
  RESULTS
  Any patient taking at least 1 anticholinergic medication had a 2.32 increased odds (P=.03) of experiencing hoarseness. If the patient was taking 2 or more anticholinergic medications, those odds rose to 4.52 (P=.009).
  
  
  CONCLUSIONS
  This is the first study, to our knowledge, that implicates medication use as a major risk factor for dysphonia of unclear etiology. An awareness of this association is invaluable when attributing cause to hoarseness and when considering treatment options.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA sunny.haft@gmail.com.
authors.forename: Sunny
authors.initials: S
authors.lastname: Haft
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Farquhar
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Carey
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Natasha
authors.initials: N
authors.lastname: Mirza
mesh_terms: D018680:Cholinergic Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000150:complications*; D005260:Female; D006685:Hoarseness / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D063189:Symptom Assessment / Q000379:methods
chemical_list: D018680:Cholinergic Antagonists
keywords: GRBAS; RSI; VHI; anticholinergic; dysphonia; hoarseness; laryngitis; medications; sicca; voice