Iranian Journal of Medical Sciences

Document Type : Letter to Editor

Authors

1 Department of Traditional Medicine, School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran

2 Research Institute for Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran

3 Student Research Committee, Iran University of Medical Sciences, Tehran, Iran

4 Department of Traditional Medicine, School of Medicine, Abadan University of Medical Sciences, Abadan, Iran

5 Department of Otorhinolaryngology, School of Medicine, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran

6 Patient Safety Research Center, Department of Biostatistics and Epidemiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran

7 Department of Traditional Pharmacy, School of Persian Medicine, Iran University of Medical Sciences, Tehran, Iran

Abstract

Dysphonia is a common voice disorder that affects about one-third of the population at some point in their lives.1 The terms dysphonia and hoarseness are frequently used interchangeably. However, dysphonia is a disorder characterized by changes in vocal quality, pitch, and loudness or vocal effort. Patients with dysphonia are unable to communicate properly, and their voice-related quality of life (VR-QOL) is negatively affected. 

Keywords

Dear Edito

Dysphonia is a common voice disorder that affects about one-third of the population at some point in their lives. 1 The terms dysphonia and hoarseness are frequently used interchangeably. However, dysphonia is a disorder characterized by changes in vocal quality, pitch, and loudness or vocal effort. Patients with dysphonia are unable to communicate properly, and their voice-related quality of life (VR-QOL) is negatively affected. On the other hand, hoarseness is the symptom of a change in voice quality as perceived by the patients. Dysphonia affects people of all ages and sex, but is more common among older adults and professions requiring considerable vocal demands. 1 While dysphonia is primarily caused by benign or self-limiting conditions, it may also be indicative of a serious or progressive disease such as head and neck cancer that requires prompt diagnosis and treatment. Other causes of dysphonia include neurological, gastrointestinal, musculoskeletal, psychological, and trauma disorders, as well as rheumatologic/autoimmune, allergic, pulmonary, and infectious diseases. 1 , 2 Various treatment modalities have been proposed to address the underlying medical conditions related to dysphonia and voice disorder, e.g., voice therapy, augmentative and alternative communication, and surgery. Palliative care provides symptomatic relief and can significantly improve VR-QOL in these patients. 2

Ibn Sina (980-1037 AD), known as Avicenna in the Western world, recognized dysphonia as an illness and proposed various treatments. He is a renowned Persian polymath during the Islamic Golden Age (8th to 13th century AD), who profoundly contributed to our current understanding of medicine. 3 His masterpiece “Al-Qānūn fī al-Tibb” (the Canon of Medicine) is an encyclopedia of medicine used as the standard medical textbook in Europe until the 17th century. 4 In the third volume of the Canon of Medicine, Avicenna discussed the clinical manifestations and treatments of diseases associated with different organ systems in the human body separately. In the section “bohūhat os-sawt/khoshūnat os-sawt” (the chapter on lung and thoracic diseases), Avicenna detailed signs and symptoms of dysphonia/hoarseness similar to the clinical manifestations presented above. 5 At the beginning of the chapter, Avicenna briefly explained the anatomical parts responsible for sound production in a clinically oriented manner. He then described clinical manifestations, basic mechanisms, etiological factors, and treatment strategies of diseases affecting the respiratory system and thorax. In detail, he explained the signs, symptoms, and treatment of voice disorders, especially dysphonia. He described a hoarse voice as being similar to the sound of birds like “Dorna” (crane), which could be caused by dry dystemperament (DD). 5 He described the underlying causes of a hoarse voice, including exposure to extreme air temperatures, lying awake at night for too long, consumption of certain foods (too salty, spicy, and sour), and vocal abuse, all of which can cause a dry throat. Additional factors include post-nasal drip or rhinorrhea, lung diseases, abnormalities in the structures of the throat near the vocal cords, etc.

Avicenna recommended certain lifestyle and dietary modifications to palliate, improve, and resolve dysphonia. 5 Given the underlying causes, such as DD, recommendations in the Canon of Medicine are presented in table 1. In addition, recommended medicinal plants (individually or in combination) are presented in table 2.

Category Recommendations
Lifestyle modifications Avoid too salty, spicy, or sour foods
Prevent vocal strain for singing and speaking
Refrain from alcoholic beverages
Gurgle grape juice with honey
Bathe with moderately warm water
Avoid prolonged exposure to extreme air temperatures
Avoid lying awake at night
Avoid overexertion
Maintain a balance of body fluids, particularly in the summer
Control anxiety and anger
Maintain healthy sexual activities
Dietary modifications Consume mashed raisins soaked in almond oil
Drink warm milk
Drink grape juice with honey
Consume fresh violet essential oil with sugar
Drink sweet pomegranate juice mixed with violet essential oil
Drink non-alcoholic beer
Eat soft boiled eggs without salt
Eat porridge with starch
Table 1.Lifestyle and dietary modifications for the management of dysphonia according to Avicenna’s masterpiece “the Canon of Medicine”
Family Scientific name Common name Traditional name Plant part
Leguminosae Vicia faba L. Broad beans Baqella Seeds
Pinaceae Pinus sylvestris L. Scotch pine Habb ol-sanobar Fruits (Pine nuts)
Vitaceae Vitis vinifera L. Raisins Zabib Dried fruits
Moraceae Ficus carica L. Common fig Tin Fruits
Leguminosae Trigonella foenum-graecum L. Fenugreek Holbah Leaves
Linaceae Linum usitatissimum L. Flax Kattan Seeds
Leguminosae Glycyrrhiza glabra L. Licorice Sus Root
Rosaceae Prunus dulcis (Mill.) D.A.Webb Almond Lawz Fruits
Poaceae Saccharum officinarum L. Sugarcane Qasab os-sokkar Brown sugar
Boraginaceae Cordia myxa L. Sebesten Sapestan Fruits
Arecaceae Phoenix dactylifera L. Date palm Tamr Fruits
Table 2.Avicenna’s recommended medicinal plants for the management of dysphonia

In brief, we have presented Avicenna’s viewpoints on dysphonia, due to DD, and his recommendations on lifestyle and dietary modifications, as well as the use of specific medicinal herbs. Some of these are still effective for the palliation of dysphonia and hoarseness. Further clinical studies are required to evaluate their effectiveness.

Authors’ Contribution

M.S. contributes to the initial idea of the study and revised the final draft for important intellectual content; M.D. helped in the study design and collected the data and drafted the manuscript; A.B. and H.R.Kh. helped in the study design and collected the data and revised the final draft for important intellectual content; O.S. and R.S. was the main supervisor of this study and contributes to the initial idea of the study and revised the final draft for important intellectual content; All authors have read and approved the final manuscript and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Conflict of Interest: None declared.

References

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