115 Examination of Voice Changes up to Five Years After Burn Injury

TL;DR

This study finds that voice changes after burn injuries can last up to five years, with intubation and tracheostomy being major contributing factors.

Contribution

The study provides new insights into the long-term prevalence and risk factors for voice changes in burn survivors.

Findings

Voice changes were reported by 16.4% at discharge and persisted in 11.6-12.7% over five years.

Mechanical ventilation and tracheostomy were strongly associated with long-term voice changes.

Those on ventilators for more than 21 days had an 83.3% tracheostomy rate and 48.7% voice change incidence at 12 months.

Abstract

Voice plays a prominent role in verbal communication and social interactions. Acute burn care often includes intubation, mechanical ventilation and tracheostomy, which may impact voice quality. However, the issue of long-term dysphonia remains underexplored. Thus, this study aims to examine the frequency of and associated factors with voice changes long term in the burn population.

Adult data from a multicenter longitudinal database from 2015-2023 were analyzed. The frequency of self-reported vocal changes (yes/no) was examined at discharge and 6, 12, 24, and 60 months after injury. Demographic and clinical data were compared between those with and without vocal changes at 12 months after injury. An omnibus chi-square test examined the incidence of voice changes among burn survivors based on ventilator days. Additionally, the percentage of tracheostomies by ventilator days was observed and compared amongst those with and without a voice change. Logistic regression analysis examined the associations between demographic and clinical factors and self-reported voice change at 12 months.

A total of 582 individuals with burn injuries were included (65 with and 517 without voice change at 12 months). Voice changes were most commonly reported at discharge (16.4%) and persisted over the 60-month follow up period (11.6-12.7%). Those with voice changes were more likely to have had a flame burn, inhalation injury, tracheostomy, outpatient speech-language pathology, head/neck burn, larger burn size, mechanical ventilation, more ventilator days, and multiple trips to the operating room than those who reported no voice changes (p < 0.001). Increasing frequency of voice changes is associated with greater ventilator days (p < 0.001). For those on a ventilator more than 21 days, 48.7% experience voice changes at 12 months and 83.3% had received a tracheostomy. The regression analysis demonstrates that individuals that were placed on a ventilator and received a tracheostomy were more likely to report a voice change at 12 months (284%, p=0.027 and 431%, p< 0.001, respectively).

Voice changes were frequently observed in people living with a burn injury, showing that symptoms can persist for up to five years after injury. Mechanical ventilation and tracheostomy were the primary factors associated with persistent voice changes after injury. Future studies could explore the impact of speech-language pathology and other interventions on individuals experiencing long-term dysphonia following burns.

This study emphasizes the need to understand the long-term voice effects of intubation and tracheostomy in burn care.