Effect of Fasting on Voice in Women * Abdul-Latif Hamdan, †Abla Sibai, and *Charbel Rameh *†Beirut, Lebanon Summary: Objective/Hypothesis: to study the effect of fasting on voice in women: abstinence from food and water intake between 14 and 18 hours. Study Design: a prospective study on female subjects. Material and Method: A total of 28 female subjects were included in this study. Their age ranged between 21 and 45 years. Subjects with vocal symptoms or vocal fold lesions were excluded. The subjects were tested when they were not fasting and while fasting after the first week of intermittent fasting during Ramadan. Each subject was first asked about her vocal symptoms and the ease of pho- nation or phonatory effort. Then each underwent acoustic analysis and laryn- geal video-endostroboscopy. Results: Vocal fatigue was the most common reported complaint (53.6%) followed by deepening of the voice (21.4%) and harshness (10.2%). Self-reported phonatory effort was significantly affected by fasting (P value ! 0.001). Out of the 28 subjects, 23 had an increase in their phonatory effort. Vocal acoustic parameters did not change markedly except for the maximum phonation time, which decreased signifi- cantly. Laryngeal video-endostroboscopy did not reveal any significant changes during fasting. All stroboscopic parameters were the same except for a decrease in the amplitude of the mucosal waves in one subject and the presence of a posterior chink in three subjects. Conclusion: Fasting affects voice. There is an increase in the phonatory effort, and vocal fatigue is the most common symptom. Key Words: Fasting—Voice—Dehydration. INTRODUCTION Fasting overnight can lead to fluid deficit measured up to 1 L after 8 hours of abstinence. 1 Consequently, dehydration, electrolyte imbalance, malnutrition, and general malaise may occur. This condition warrants serious attention and the need for fluid administration to alleviate the pa- tient’s discomfort. As a result, a new consensus in the preoperative requirement for general anes- thesia is being reformed. 2 During the month of Ramadan, Moslems refrain from drinking and eating between sunrise and sun- set. The effect of this intermittent lack of water and food intake on the well-being of the participant has been studied in various groups. Most studies agree that there are significant metabolic changes with slowing down of the body metabolism during the day to conserve energy stores. 3 The changes in the lifestyle witnessed during this month of fasting Accepted for publication January 24, 2006. From the *Department of Otolaryngology Head and Neck Surgery, American University of Beirut Medical Center, Beirut, Lebanon; and the †Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon. Address correspondence and reprint requests to Abdul-Latif Hamdan, MD, FACS, American University of Beirut, Depart- ment of Otolaryngology, PO Box 11-0236, Beirut, Lebanon. E-mail: alhamdan@svclb.com Journal of Voice, Vol. 21, No. 4, pp. 495–501 0892-1997/$32.00 Ó 2007 The Voice Foundation doi:10.1016/j.jvoice.2006.01.009 495