Advertisement

Voice Outcomes After Bariatric Surgery: A Systematic Review

Published:January 12, 2023DOI:https://doi.org/10.1016/j.jvoice.2022.12.019

      Summary

      Objective

      Bariatric surgery has been documented to improve comorbidities associated with obesity. Obesity can cause deposition of excess adipose tissue, narrowing of the vocal tract, and decreased lung capacity contributing to reduced vocal quality and increased vocal effort. Limited information is available regarding the impact of bariatric surgery on voice outcomes. This review seeks to examine the role of bariatric surgery on voice outcomes.

      Study Design

      Systematic review.

      Methods

      A systematic review was completed using PubMed and Embase for measures of vocal change before and after bariatric surgery. Studies were reviewed by three authors, and data related to acoustic, aerodynamic, auditory-perceptual, and patient-reported outcome measures were extracted.

      Results

      Forty-nine abstracts were identified with seven meeting criteria for analysis. Voice outcomes pre and postbariatric surgery were measured across 122 individuals. Results revealed increased fundamental frequency (F0) and increased maximum phonation time (MPT) during sustained vowel productions. Correlation coefficients for MPT for /a/ were -0.683 and -0.725 for F0, respectively, indicating a strong negative correlation between body mass index and MPT and F0. Trends toward improved auditory-perceptual ratings and improved patient-reported outcome measures were also noted. However, studies were limited by restricted patient demographics and limited use of standardized and/or comprehensive evaluation techniques.

      Conclusion

      Weight loss associated with bariatric surgery can result in improved voice outcomes; however, the mechanism by which it helps is unclear. To better understand this, otolaryngologists and speech-language pathologists may consider advocating for pre- and postsurgery voice evaluation in patients undergoing bariatric surgery.

      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:

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

      REFERENCES

      1. Hua Y, Lou Y, Li C, et al. Clinical outcomes of bariatric surgery - updated evidence. Obes Res Clin Pract.16:1–9. https://doi.org/10.1016/j.orcp.2021.11.004.

        • Dixon AE
        • Peters U.
        The effect of obesity on lung function.
        Expert Rev Respir Med. 2018; 12: 755-767https://doi.org/10.1080/17476348.2018.1506331
        • Solomon NP
        • Helou LB
        • Dietrich-Burns K
        • et al.
        Do obesity and weight loss affect vocal function?.
        Semin Speech Lang. 2011; 32: 031https://doi.org/10.1055/s-0031-1271973
        • Martinho FL
        • Tangerina RP
        • Moura SMGT
        • et al.
        Systematic head and neck physical examination as a predictor of obstructive sleep apnea in class III obese patients.
        Braz J Med Biol Res. 2008; 41: 1093-1097https://doi.org/10.1590/s0100-879×2008001200008
        • de Souza L
        • Bernadete R
        • dos Santos MM
        • et al.
        Effects of weight loss on acoustic parameters after bariatric surgery.
        Obes Surg. 2017; 28: 1372-1376https://doi.org/10.1007/s11695-017-3018-6
        • de Souza LBR
        • Pernambuco LdA
        • dos Santos MM
        • et al.
        Vocal complaint, auditory-perceptual assessment of voice and vocal self-assessment in women with morbid obesity.
        . Arq Bras Cir Dig. 2015; 28: 23-25https://doi.org/10.1590/S0102-6720201500S100008
        • de Souza L
        • Bernadete R
        • Pernambuco LdA
        • et al.
        Neck circumference and vocal parameters in women before and after bariatric surgery.
        Obes Surg. 2015; 26: 576-580https://doi.org/10.1007/s11695-015-1785-5
        • Bosso JR
        • Tavares ELM
        • Rodrigues SA
        • et al.
        Does abrupt weight loss caused by bariatric surgery compromise the voice in women?.
        J Voice. 2021; https://doi.org/10.1016/j.jvoice.2021.03.007
        • Hamdan A
        • Safadi B
        • Chamseddine G
        • et al.
        Effect of weight loss on voice after bariatric surgery.
        J Voice. 2014; 28: 618-623https://doi.org/10.1016/j.jvoice.2014.03.004
        • Fonseca ALF
        • Salgado W
        • Dantas RO.
        Maximum phonation time in people with obesity not submitted or submitted to bariatric surgery.
        J Obes. 2019; 2019: 5903621-5903625https://doi.org/10.1155/2019/5903621
        • Eravci FC
        • Yildiz BD
        • Özcan KM
        • et al.
        Acoustic parameter changes after bariatric surgery.
        Logoped Phoniatr Vocol. 2021; 1https://doi.org/10.1080/14015439.2021.1945676
        • Kempster GB
        • Gerratt BR
        • Verdolini Abbott K
        • et al.
        Consensus auditory-perceptual evaluation of voice: development of a standardized clinical protocol.
        Am J Speech Lang Pathol. 2009; 18: 124-132https://doi.org/10.1044/1058-0360(2008/08-0017)
        • Hirano M.
        Clinical Examination of Voice.
        Springer-Verlag, 1981
        • Jacobson Barbara H
        • Alex J
        • Cynthia G
        • et al.
        The Voice Handicap Index (VHI).
        Am J Speech Lang Pathol. 1997; 6: 66-70https://doi.org/10.1044/1058-0360.0603.66
        • Hogikyan ND
        • Sethuraman G.
        Validation of an instrument to measure voice-related quality of life (V-RQOL).
        J Voice. 1999; 13: 557-569https://doi.org/10.1016/S0892-1997(99)80010-1
        • Wei Y
        • Tseng W
        • Huang C
        • et al.
        Surgically induced weight loss, including reduction in waist circumference, is associated with improved pulmonary function in obese patients.
        Surg Obes Relat Dis. 2011; 7: 599-604https://doi.org/10.1016/j.soard.2011.04.221
        • Evans S
        • Neave N
        • Wakelin D.
        Relationships between vocal characteristics and body size and shape in human males: an evolutionary explanation for a deep male voice.
        Biol Psychol. 2006; 72: 160-163https://doi.org/10.1016/j.biopsycho.2005.09.003
        • van Dommelen WA
        • Moxness BH.
        Acoustic parameters in speaker height and weight identification: sex-specific behaviour.
        Lang Speech. 1995; 38: 267-287https://doi.org/10.1177/002383099503800304
        • Evans S
        • Neave N
        • Wakelin D
        • et al.
        The relationship between testosterone and vocal frequencies in human males.
        Physiol Behav. 2007; 93: 783-788https://doi.org/10.1016/j.physbeh.2007.11.033
        • Gates MA
        • Mekary RA
        • Chiu GR
        • et al.
        Sex steroid hormone levels and body composition in men.
        J Clin Endocrinol Metab. 2013; 98: 2442-2450https://doi.org/10.1210/jc.2012-2582
        • Busetto L
        • Enzi G
        • Inelmen EM
        • et al.
        Obstructive sleep apnea syndrome in morbid obesity: effects of intragastric balloon.
        Chest. 2005; 128: 618-623https://doi.org/10.1378/chest.128.2.618
        • Bright L
        • Secko M
        • Mehta N
        • et al.
        Is there a correlation of sonographic measurements of true vocal cords with gender or body mass indices in normal healthy volunteers?.
        J Emerg Trauma Shock. 2014; 7: 112-115https://doi.org/10.4103/0974-2700.130881
        • Awan SN
        • Roy N
        • Jetté ME
        • et al.
        Quantifying dysphonia severity using a spectral cepstral-based acoustic index: comparisons with auditory-perceptual judgements from the CAPE-V.
        Clin Linguist Phon. 2010; 24: 742-758https://doi.org/10.3109/02699206.2010.492446
        • Kochkodan J
        • Telem DA
        • Ghaferi AA.
        Physiologic and psychological gender differences in bariatric surgery.
        Surg Endosc. 2018; 32: 1382-1388https://doi.org/10.1007/s00464-017-5819-z
        • DeCherney AH
        • Bachmann G
        • Isaacson K
        • et al.
        Postoperative fatigue negatively impacts the daily lives of patients recovering from hysterectomy.
        Obstet Gynecol. 2002; 99: 51-57https://doi.org/10.1016/S0029-7844(01)01622-2
        • Eckel FC
        • Boone DR.
        The S/Z ratio as an indicator of laryngeal pathology.
        J Speech Hear Disord. 1981; 46: 147-149https://doi.org/10.1044/jshd.4602.147
        • Johnson AM
        • Goldfine A.
        Intrasubject reliability of maximum phonation time.
        J Voice. 2015; 30: 775.e1-775.e4https://doi.org/10.1016/j.jvoice.2015.11.019
        • Patel RR
        • Awan SN
        • Barkmeier-Kraemer J
        • et al.
        Recommended protocols for instrumental assessment of voice: American Speech-Language-Hearing Association Expert Panel to develop a protocol for instrumental assessment of vocal function.
        Am J Speech Lang Pathol. 2018; 27: 887-905https://doi.org/10.1044/2018_AJSLP-17-0009
        • Bal J
        • Ilonzo N
        • Adediji T
        • et al.
        Gender as a deterministic factor in procedure selection and outcomes in bariatric surgery.
        JSLS. 2021; 25https://doi.org/10.4293/JSLS.2020.00077
        • Kleber B
        • Veit R
        • Moll CV
        • et al.
        Voxel-based morphometry in opera singers: increased gray-matter volume in right somatosensory and auditory cortices.
        Neuroimage. 2016; 133: 477-483https://doi.org/10.1016/j.neuroimage.2016.03.045
        • Salomoni S
        • van den Hoorn W
        • Hodges P.
        Breathing and singing: objective characterization of breathing patterns in classical singers.
        PLoS One. 2016; 11e0155084https://doi.org/10.1371/journal.pone.0155084