Two Cases of Voice Changes in Pregnancy

Abstract

Vocal changes that occur with pregnancy are referred to as pregnancy-related laryngeal disorders, and postpartum remission is considered characteristic. We report two patients in whom fundamental frequency (F₀) became markedly lower with pregnancy, and failed to recover after birth. Patient 1 : A 33-year-old woman presented with markedly lower voice from about the third month of pregnancy. On examination, her F₀ was 127 Hz, her vocal range was 118-511 Hz, and no organic lesions were apparent. In a test of male hormones, testosterone was within the normal range, but androsterone was about twice the normal level. When menstruation resumed 1 year later, her F₀ had changed to 152 Hz and her vocal range to 141-555 Hz. Her androsterone level had also decreased to near normal. She later became pregnant and gave birth again, but experienced no change in F₀. Patient 2 : A 35-year-old woman was examined for lowering of the F₀ from about the sixth month of pregnancy. On presentation, F₀ was 133 Hz and vocal range was 82-606 Hz. Neither patient desired aggressive treatment, so they were kept under observation. In both patients, the vocal range was about 30 semitones. This was within the normal range, but F₀ decreased and shifted toward the lower limit of the vocal range. Symptoms were thought to be similar to voice masculinization from hormone-related vocal disorders, such as instability near the vocal register change during phonation.