Symptom Complexes Index: Endocrine Disorders

• Etiology
• Diagnosis
  • History
  • Vocal Capability Testing
  • Laryngeal exam
• Treatment
  • Medical
  • Behavioral
  • Surgical

Etiology

The history is a very significant element since there is not a lot to see visually in this vocal impairment. There is a gradual change or impairment in the upper register. The most common patient is a female singer. Either the lack of estrogen or the addition of testosterone gradually changes the voice in the same way that puberty does for a young male.

Diagnosis

History

The speaking voice is usually unchanged, but there is a gradual diminishment in the overall vocal range, mostly a loss of the upper range. There may be unanticipated voice breaks in a patient who otherwise has excellent control over the voice. Their singing range may have changed from soprano to alto or alto to tenor. Trying to remain in their usual vocal range is very fatiguing. Testosterone is currently prescribed to females wishing to increase their sexual drive, which it is effective at.

Character of a patient with a vocal endocrine impairment

• variable
• Talkativeness scale: any

Vocal capabilities

• General
  • Normal clear voice
• Reading voice
  • The pitch may be a low in the female range or perhaps lower than previously. This may not be noticeable unless there is a previous recording.
• Pitch range
  • Depending on the length of time without estrogen (or even a smaller interval on testosterone) the upper range decreases and the notes sound tight or strained. There may be sudden pitch jumps.
• Singing
  • tight or flatting at the upper end of the upper register
• Yelling voice
  • normal

Laryngeal Exam

• Videolaryngeal exam
  • Rigid and flexible exams are usually visually normal
• Stroboscopy - normal vibrations

Treatment

Medical

• Stopping testosterone may result in a gradual return of a few semi-tones. The upper range will likely at least stop lowering. It is unlikely to recover most of the lost range.
• Starting estrogen may be helpful in preventing further loss of range. Again a few notes may return at the upper end, but this is more of a “preventing progression” approach

Behavioral

• Speech Therapy probably has limited usefulness
• Feedback to primary care physicans and OB/Gyns that lack of estrogen or the addition of testosterone will usually only be noted in the upper range and thus significantly impact singers may help them to include this in their discussion of the pros and cons of taking medication.

Surgical

None