Vapers report voice fatigue, and it tracks with a dry mouth

Design

cross-sectional survey with a frequency-matched non-smoking control group, recruited from public cafes; linear regression for the xerostomia association

Population

260 adults aged 18-65: 130 current e-cigarette users and 130 non-smokers matched by age and gender; 80 completed the Xerostomia Inventory

Primary outcome

voice fatigue on a visual analogue scale and self-reported running out of air when speaking, and their correlation with xerostomia

Effect

VAS 2.01 (SD 2.35) vs 0.53 (1.15), p < 0.001; running out of air 0.72 vs 0.34, p < 0.001; Xerostomia Inventory 22.35 vs 15.95; regression beta 0.656 (adjusted p < 0.001)

This survey recruited 130 adult e-cigarette users from public cafes and 130 non-smokers frequency-matched for age and gender, and asked about voice fatigue on a visual analogue scale and about running out of air when speaking.

Both were worse in the e-cigarette group: mean VAS 2.01 (SD 2.35) against 0.53 (1.15), and running out of air 0.72 (0.94) against 0.34 (0.66), both p < 0.001. In a subgroup of 40 in each arm who completed the Xerostomia Inventory, scores were 22.35 (7.30) against 15.95 (4.50), and xerostomia score correlated with voice fatigue on regression (beta 0.656, adjusted p < 0.001) and, more weakly, with running out of air (beta 0.245, adjusted p = 0.040).

The mechanism proposed — that vaping dries the vocal tract and a dry mucosa fatigues — is plausible, and it points at something a clinician can act on, since hydration and humidification are available in a way that quitting sometimes is not. But this is a cross-sectional café survey with self-reported exposure and self-reported symptoms, so it cannot establish direction, and people who already notice voice symptoms may report their vaping differently. The standard deviations also exceed the means in the vaping group, which means most participants reported little fatigue and a minority reported a lot. The usable point is narrower than the headline: ask about vaping in a patient presenting with voice fatigue, and check for xerostomia when you do.

• Ask specifically about e-cigarette use in any patient presenting with voice fatigue
• Assess for xerostomia at the same visit; the two travelled together
• Offer hydration and humidification advice as a first, low-cost intervention
• Do not present this as proof that vaping causes voice fatigue — the design cannot show direction
• Standard deviations exceeded the means, so a minority with marked symptoms drove the group difference

The statistics, in plain English

A mean VAS of 2.01 with a standard deviation of 2.35 means the distribution is heavily skewed — most participants near zero, some much higher — so the mean overstates the typical vaper's experience. A regression beta of 0.656 for xerostomia against voice fatigue indicates a moderate association, not a causal pathway, and both variables were self-reported by the same person at the same sitting, which inflates correlations. The xerostomia comparison rests on 40 participants per arm, a quarter of the recruited sample, chosen by who agreed to complete a second questionnaire.

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