Voice Loss, Hoarseness, & Lupus Symptoms

Lupus Warriors know that lupus symptoms can show up all throughout the body, from head to toe. Recent research suggests another potential lupus sign: voice loss.

At an overview level, let’s start by exploring how the speaking voice is produced. There are 3 main functions necessary to create the voice (as described by the American Academy of Otolaryngology- Head and Neck Surgery):

1. The Power Source — The Lungs
   • Vocal power comes from exhaled air. When exhaling, there is an airstream created in the windpipe (trachea) which powers vocal cord vibration.
2. The Vibrator — The Voice Box
   • The voice box (larynx) is found at the top of the windpipe and contains the vocal cords. Vocal cords are folds that open and close when breathing, eating, etc.
   • When speaking, the folds come together and vibrate as the air passes through them.
   • They vibrate between 100 and 1,000 times per second — this speed variation adjusts the pitch that is created, and is controlled by muscles in the larynx.
3. The Resonator — The Throat, Nose, Mouth, & Sinuses
   • The resonator elements of the vocal production system turn the buzzing created by the vocal folds vibrations into the sounds that we recognize as language.

What is voice loss?

When speaking about voice loss, we are typically talking about a hoarse, breathy voice which is known by the name ‘dysphonia.’ By itself, dysphonia is not simply a symptom of lupus. It can be caused by laryngitis, a cold, allergies, or even speaking or singing too loudly without resting (like cheering or screaming).

The timbre of the voice may also change in other ways. It could be raspy, strained, or simply softer and lower in pitch.

Lupus & voice loss

Although voice loss isn’t a well-recognized sign of lupus, there are people discussing the symptom in online communities. For many people, it seems to be most prevalent during flares and the severity of the voice loss varies from person to person. Lupus Warriors have reported mild hoarseness to total voice loss that can last for several days.

A case study from 1996 published in the Journal of Laryngology & Otology  provided details about a woman who reported being hoarse for two years. Her clinicians found nodules on her vocal folds that were similar to rheumatoid nodules.

Rather than perform surgery, the clinicians treated the nodules with prednisolone. This not only helped the symptoms, it also led the doctors to diagnose atypical-SLE.

Recent research has expanded on this case study. Published in 2017, researchers measured the vocal quality and self-reported vocal difficulties of 36 people with lupus and control participants. Vocal quality was measured using the GRBAS scale which measures:

• Grade
• Roughness
• Breathiness
• Asthenia (physical weakness of voice)
• Strain

The researchers found that people with lupus had “significantly lower vocal intensity and harmonics to noise ratio, as well as increased jitter and shimmer” in their voices. Most people reported at least one vocal deficit (29 out of 36 participants) with the most common symptoms being vocal fatigue and dysphonia.

Additionally, the researchers looked into tissue damage in the organ systems related to dysphonia. They found that increased tissue damage was correlated with increased symptoms. This suggests that the voice loss was due to tissue damage potentially caused by SLE.

Lupus and the cricoarytenoid joint

The connection between voice issues and lupus appears to be related to the only joint in the throat: the cricoarytenoid joint. The cricoarytenoid joints, located in between the cricoid and paired arytenoid cartilage in the larynx, are diarthrodial joints that tighten the vocal cords during speech and breathing and help them to open and close.

As a diarthrodial joint, the cricoarytenoid joint has a fibrous joint capsule around it that consists of synovial fluid that lubricates the outside portion of the bones. Lupus causes inflammation that affects the synovial lining, which in return, places pressure on the vocal cords. The swelling is what is thought to cause the voice issues with lupus.

Battling voice loss

If you are experiencing consistent voice loss that can’t be linked to some external factor, you may wish to consult with your lupus treatment team. In addition to adhering to any medications prescribed by your treatment team, you should try to get an adequate amount of sleep and consume a well-balanced diet. Additionally, it’s important to avoid stress in limit inflammation.