Eur Arch Otorhinolaryngol (2009) 266:1759–1765 DOI 10.1007/s00405-009-1003-y 123 LARYNGOLOGY Vocal symptoms and acoustic changes in relation to the expanded disability status scale, duration and stage of disease in patients with multiple sclerosis Bassem Yamout · Nabil Fuleihan · Taghrid Hajj · Abla Sibai · Omar Sabra · Hani Rifai · Abdul-Latif Hamdan Received: 31 July 2008 / Accepted: 15 May 2009 / Published online: 10 June 2009  Springer-Verlag 2009 Abstract Vocal symptoms and acoustic measures of patients with multiple sclerosis (MS) are investigated in relation to the duration of the disease, stage of the disease and the degree of disability. Eighty-two patients were enrolled in this study (40 MS, 42 controls). In the MS group, the most common vocal symptoms were vocal breaks and vocal fatigue present in 10. None of the patients in the control group had voice breaks. In the male group, there was a signiWcant decrease in the fundamental fre- quency, habitual pitch and maximum phonation time with a signiWcant increase in Shimmer. In the female group, there was a signiWcant decrease in the maximum phonation time only. There was no correlation between vocal symptoms and acoustic measures versus duration of the disease and extent of disability except for vocal fatigue which signiW- cantly associated with EDSS (expanded disability status scale) score. Patients with MS may develop vocal symp- toms irrespective of the EDSS score, duration and stage of the disease. Vocal fatigue and vocal breaks are more com- mon than hoarseness. Keywords Multiple sclerosis (MS) · Vocal fatigue · EDSS · Acoustic analysis Introduction Phonation is a reXection of the entire wellbeing, a physio- logic process that requires interplay and coordination of various systems in the body including the neurologic sys- tem. As such, laryngeal pathophysiology very often reXects neuromuscular or musculoskeletal systemic disorders with dysphonia being one of the earliest presenting symptoms [1]. Multiple sclerosis (MS) is a chronic degenerative dis- ease that can involve most motor functional systems. The prevalence has ranged from 2.5/100,000 to 39/100,000 and recent studies have indicated a rise over the last two decades that could be partially attributed to better ascertain- ment [2, 3]. It is a disease that aVects the myelin sheath of the central nervous system and results in multiple lesions of the brain white matter, brainstem and spinal cord. Very often, multiple sclerotic plaques are found in the brainstem and upper cervical spine of patients with multiple sclerosis. As a result, symptoms and signs of the pyramidal, cerebel- lar and brainstem systems may be present such as spasticity, weakness, ataxia, tremor, language disorders, dysphonia, dysarthria, dysphagia and even emotional alterations [4–6]. Dysphonic symptoms have been explained based on the alterations in the neuronal concentration and projection in the periaqueductal gray matter, a Wnding commonly seen in patients with MS [7, 8]. A physician with good auditory perceptual skills may use the phonatory characteristics of a neurologically impaired patient to draw relevant clinical information with respect to diagnosis, location of injury and progress of disease. Highlighting the distinct phonatory disturbances in patients with MS can help us introduce new N. Fuleihan · O. Sabra · H. Rifai · A.-L. Hamdan (&) Department of Otolaryngology/Head and Neck Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Beirut, Lebanon e-mail: alhamdan@svclb.com A. Sibai Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon B. Yamout · T. Hajj Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon