Self-reported voice symptoms in e-cigarette users: a cross-sectional study.

BACKGROUND: Electronic cigarette (e-cigarette) use has risen sharply, particularly among young adults who tend to view vaping as safer than conventional smoking. The larynx and vocal folds sit directly in the path of inhaled aerosols, yet the impact of e-cigarette use on voice remains poorly described, particularly in Saudi Arabia. OBJECTIVE: To assess self-reported voice handicap among current, former, and never e-cigarette users in Saudi Arabia using the Voice Handicap Index-10 (VHI-10), and to examine factors linked to abnormal voice scores. METHODS: An online cross-sectional survey of 1,445 adults was carried out across Saudi Arabia from July to August 2025. Participants were categorized by smoking status as current e-cigarette users, former users, conventional smokers, or never smokers. The survey collected data on demographics, smoking behavior, and voice handicap using the VHI-10. Statistical analysis included t-tests, chi-square tests, Pearson correlations, and multivariable logistic regression. RESULTS: Former e-cigarette users recorded higher VHI-10 scores (3.9 ± 6.9) than current users (2.2 ± 4.7, p = 0.002). Multivariable logistic regression revealed that former users had higher odds of abnormal voice scores than current users (OR = 1.85, 95% CI: 1.04–3.36, p = 0.038). Current users reported longer duration of use, higher daily consumption, and higher nicotine concentration. Perceptions of e-cigarette risks differed across groups, with current users more likely to rate vaping as less harmful. CONCLUSION: E-cigarette use relates to measurable self-reported voice handicap, and former users report more vocal difficulties than current users. This pattern may reflect consistent with more noticeable symptoms among former users or limited awareness of vocal problems among individuals who continue to vape. LEVEL OF EVIDENCE: level 4. This study is Level 4 evidence because it is observational, crosssectional, and lacks randomization, followup, or the ability to determine causality. It relies on selfreported subjective data (VHI10) with limited control of confounders, and it is not a cohort study, RCT, or systematic review.