Journal of voice : official journal of the Voice Foundation · 2026
Comparative Effects of Heated Tobacco Products and Conventional Cigarettes on Voice Function and Nasal Mucociliary Clearance: A Multidimensional Cross-Sectional Study.
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Ibas Mustafa, Manay Burak, Senturk Alperen, Elgormus Mehmet Nuri
Аннотация
OBJECTIVE: This study evaluated the effects of heated tobacco product (HTPs, IQOS®) use on multidimensional vocal function and nasal mucociliary clearance (NMC), and compared these findings with those of conventional cigarette users and never-smokers.
METHODS: In this cross-sectional study, 75 adults were allocated to three groups (n = 25 each): exclusive IQOS users, exclusive cigarette smokers, and individuals with no history of tobacco use. Participants underwent standardized multidimensional assessment, including grade, roughness, breathiness, asthenia, strain perceptual ratings, voice handicap index-10 (VHI-10), maximum phonation time (MPT), S/Z ratio, acoustic analysis (fundamental frequency, jitter, shimmer, harmonics-to-noise ratio), and saccharin transit time for NMC. Primary outcomes were analyzed with false discovery rate correction. Exposure-adjusted multivariable regression models were performed among tobacco users to evaluate the independent effects of product type while controlling for cumulative exposure and age.
RESULTS: Cigarette users demonstrated the greatest impairment across acoustic, aerodynamic, perceptual, and nasal parameters, whereas IQOS users showed intermediate alterations compared with controls. Exposure-adjusted analyses confirmed that product type remained independently associated with multiple outcomes, including jitter, shimmer, MPT, S/Z ratio, VHI-10 scores, and NMC time. These findings indicate that observed differences were not solely attributable to cumulative exposure.
CONCLUSION: A consistent pattern of physiological impairment was observed across cigarette users, IQOS users, and never-smokers. Although IQOS use was associated with less severe alterations than conventional smoking, measurable functional changes were still observed, indicating that HTPs exposure may not be physiologically inert. Multidimensional assessment provides important insight into the upper airway effects of emerging tobacco technologies.
METHODS: In this cross-sectional study, 75 adults were allocated to three groups (n = 25 each): exclusive IQOS users, exclusive cigarette smokers, and individuals with no history of tobacco use. Participants underwent standardized multidimensional assessment, including grade, roughness, breathiness, asthenia, strain perceptual ratings, voice handicap index-10 (VHI-10), maximum phonation time (MPT), S/Z ratio, acoustic analysis (fundamental frequency, jitter, shimmer, harmonics-to-noise ratio), and saccharin transit time for NMC. Primary outcomes were analyzed with false discovery rate correction. Exposure-adjusted multivariable regression models were performed among tobacco users to evaluate the independent effects of product type while controlling for cumulative exposure and age.
RESULTS: Cigarette users demonstrated the greatest impairment across acoustic, aerodynamic, perceptual, and nasal parameters, whereas IQOS users showed intermediate alterations compared with controls. Exposure-adjusted analyses confirmed that product type remained independently associated with multiple outcomes, including jitter, shimmer, MPT, S/Z ratio, VHI-10 scores, and NMC time. These findings indicate that observed differences were not solely attributable to cumulative exposure.
CONCLUSION: A consistent pattern of physiological impairment was observed across cigarette users, IQOS users, and never-smokers. Although IQOS use was associated with less severe alterations than conventional smoking, measurable functional changes were still observed, indicating that HTPs exposure may not be physiologically inert. Multidimensional assessment provides important insight into the upper airway effects of emerging tobacco technologies.