Research Article| Volume 37, ISSUE 3, P469.e19-469.e27, May 2023

Download started.


Hyposalivation Affecting Womens' Voice

  • Osnat Grinstein-Koren
    Department of Oral Pathology, Oral Medicine and Maxillofacial Imaging, School of Dental Medicine, Tel-Aviv University, Israel

    Oral Medicine Clinic, Maccabi Healthcare Services, Hasharon District, Israel
    Search for articles by this author
  • Nitzan Herzog
    Department of Communication Disorders, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
    Search for articles by this author
  • Ofer Amir
    Address correspondence and reprint requests to Ofer Amir, Department of Communication Disorders, Tel Aviv University, Sheba Medical Center, Tel-Hashomer 52621, Israel.
    Department of Communication Disorders, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
    Search for articles by this author
Published:January 29, 2021DOI:



      Balanced hydration is crucial for optimal physiological function, whereas hypohydration may cause adverse effects. Like many other organs, the larynx is negatively affected by hypohydration, potentially affecting voice production. Therefore, the purpose of this study was to examine voice properties in women diagnosed with dry-mouth.


      Twenty-four women diagnosed with hyposalivation and 24 age-matched controls were recruited. All participants underwent three sialometry tests for quantifying oral-dryness. These tests were conducted in three conditions: after 2-hour fasting, after gustatory salivary stimulation and after drinking water. After each sialometry, participants were recorded while producing the vowels /a/ and /i/, and during a standardized reading task. A basic set of acoustic measures was extracted from these recordings. Self-evaluation of voice was performed using the VHI-10 questionnaire; and listeners’ perception of the voice was performed by five professional judges who rated the recordings perceptually, using the GRBAS scale.


      Significant group differences were found in fundamental frequency and jitter, but not in shimmer and noise-to-harmonic ratio (corrected P < 0.05). The participants in the hyposalivation group exhibited higher scores on the VHI-10 questionnaire compared to the control group (P = 0.002), and the judges perceptually rated their voices higher on the Grade and Roughness scales (0.03 ≤ P ≤ 0.04). In contrast with the significant group differences, no significant differences were found between the three study conditions.


      Women suffering from oral-dryness were shown to exhibit degradation in voice quality, evident in both acoustic, perceptual and self-evaluation measures. However, in this paradigm, short-term superficial hydration was not shown to elicit a significant improvement in voice properties. These findings highlight the importance of consistent oral-hydration for voice, especially among people suffering from hyposalivation.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Hartley N.A.
        • Thibeault S.L.
        Systemic hydratoin: Relating science to clinical practice in vocal health.
        J Voice. 2014; 28 (652-e1)
        • Popkin B.M.
        • D'Anci K.E.
        • Rosenberg I.H.
        Water, hydration and health.
        Nutr Rev. 2010; 68: 439-458
        • Murray B.
        Hydration and physical performance.
        J Am Coll Nutr. 2007; 26: 542s-548s
        • Cian C.
        • Barraud P.A.
        • Melin B.
        • et al.
        Effects of fluid ingestion on cognitive function after heat stress or exercise-induced dehydration.
        Int J Psychophysiol. 2001; 42: 243-251
        • Ganio M.S.
        • Armastrong L.E.
        • Casa D.J.
        • et al.
        Mild dehydration impairs cognitive performance and mood of men.
        Br J Nutr. 2011; 106: 1535-1543
        • Titze I.R.
        The physics of small-amplitude oscillation of the vocal folds.
        J Acoust Soc Am. 1988; 83: 1536-1552
        • Henler R.J.
        • Wieneke G.H.
        • Dejonckere P.H.
        The effect of relative humidity of inhaled air on acoustic parameters of voice in normal subjects.
        J Voice. 1997; 11: 295-300
        • Santana E.R.
        • Masson M.L.V.
        • Arujo T.M.
        The effect of surface hydration on teachers' voice qualtiy: An intervention study.
        J Voice. 2017; 31 (383.e5-11)
        • Roy N.
        • Weinrich B.
        • Gray S.D.
        • et al.
        Three treatments for teachers with voice disorders: a randomized clinical trial.
        J Speech Lang Hear Res. 2003; 46: 670-688
        • Valtin H.
        Drink at least eight glasses of water a day.” Really? Is there scientific evidence for “8 8”?.
        Am J Physiol Regul Integr Comp Physiol. 2002; 283: R993-R1004
      1. S.-P. G., “Speech Pathology Graduate Program,” 2019. [Online]. Available at: [Accessed 30 Oct. 2019].

      2. ASHA, “ASHA - Voice Disorders,” ASHA, [Online]. 000 Available at: [Accessed 30 October 2019].

        • Carpenter G.
        Dry Mouth, A Clinical Guide on Causes, Effects and Treatment.
        Springer, Basel2015
        • O'Rahilly R.
        • Muller F.
        • Carpenter S.
        • et al.
        Basic Human Anatomy: A Regional Study of Human Sructure.
        Dartmouth Medical School, Hanover, New Hampshire2004
        • Leydon C.
        • Sivasanker M.
        • Faleiglia D.
        • et al.
        "Vocal fold surface hydration: a review.
        J Voice. 2009; 23: 658-665
        • Navazesh M.
        Methods for collecting saliva.
        Ann N Y Acad Sci. 1993; 694: 72-77
        • Sreebny L.M.
        • Vissink A.
        Dry mouth, The Malevolent Symptom: A Clinical Guide.
        Wiley-Blackwell, Ames, Iowa2010
        • Ruiz A.L.
        • Hernandez L.X.
        • Arreguin P.J.
        • et al.
        "Alterations in voice, speech and swallowing in patients with Sjogren's syndrome.
        Acta Otorinolaryngol Espanola. 2010; 62: 255-264
      3. J. Guggenheimer and P. A. Moore, “Xerostomia: etiology, recognition and Treatment,” vol. 134, no. 1, pp. 61-69, 2003.

        • Armstrong L.E.
        Assessing hydration status: the elusive gold standard.
        J Am Coll Nutr. 2007; 26: 575S-584S
        • Amir O.
        • Levine-Yundof R.
        Listeners' attitude toward people with dysphonia.
        J Voice. 2013; 27: 524.e1-524.e10
        • Sreebny L.
        Saliva in health and disease: an appraisal and update.
        Int. Sent. J. 2000; 50: 140-161
        • Ericsson Y.
        • Hardwick L.
        Individual diagnosis, prognosis and counselling for caries prevention.
        Caries Res. 1978; 12: 94-102
        • Roh J.L.
        • Kim H.S.
        • Kim A.Y.
        The effect of acute xerostomia on vocal function.
        Arch Otolaryngol-Head Neck Surg. 2006; 132: 542-546
        • Hamdan A.L.
        • Sibai A.
        • Rameh C.
        Effect of fasting on voice in women.
        J Voice. 2007; 21: 495-501
        • Salurk Z.
        • Ozdemir E.
        • Kumral T.L.
        • et al.
        "Subjective and objective voice evaluation in Sjogren's syndrome.
        Logop Phoniatr Vocol. 2017; 42: 9-11
        • Benjamini Y.
        • Hochberg Y.
        Controlling the false discovery rate: a practical and powerful approach to multiple testing.
        J Royal Stat Soc Ser B. 1995; 57: 289-300
        • Nishio M.
        • Niimi M.
        Changes in speaking fundamental frequency characteristics with aging.
        Folia Phoniatr Logop. 2008; 60: 120-127
        • Sussell A.
        • Penny L.
        • Pemberton C.
        Speaking fundamental frequency changes over time in women: a longitudinal study.
        J Speech Hear Res. 1995; 38: 101-109
        • Amir O.
        • Tavor Y.
        • Leibovitzh T.
        • et al.
        Evaluating the validity of the Voice Handicap Index-10 (VHI-10) among Hebrew speakers.
        Otolaryngol–Head Neck Surg. 2006; 135: 603-607
        • Hirano M.
        Clinical Examination of Voice.
        Springer Verlag, New York1981
        • Boersma P.
        • Weenink D.
        Praat: Doing Phonetics by Computer [Computer program].
        2019 (Ver. 6.1.05," from)
        • Baken R.
        Clinical Measurement of Speech and Voice.
        Allyn and Bacon, Boston1987
        • Amir O.
        • Wolf M.
        • Amir N.
        A clinical comparison bertween two acoustic analysis software: MDVP and Praat.
        Biomed Signal Process Control. 2009; 4: 202-205
        • Kim S.Y.
        • Lee J.
        • Choi Y.S.
        • et al.
        Do I sound dry? Comparative voice analysis of primary Sjögren's syndrome.
        Clin Expn Rheumatol. 2018; 112: 130-136
        • Ogut F.
        • Midili R.
        • Oder G.
        • et al.
        Laryngeal findings and voice quality in Sjögren's syndrome.
        Auris Nasus Larynx. 2005; 32: 375-380
        • Tanner K.
        • Nissen S.L.
        • Merrill R.M.
        • et al.
        Nabilized isotonic saline improves voice production in Sjoren's syndrome.
        Laryngoscope. 2015; 125: 2333-2340
        • Heller A.
        • Tanner K.
        • Roy N.
        • et al.
        Voice, speech, and laryngeal features of primary Sjögren's syndrome.
        Ann Otol Rhinol Laryngol. 2014; 123: 778-785