Physiological Effects of Voice Therapy for Aged Vocal Fold Atrophy Revealed by EMG Study

Objectives: Vocal fold atrophy is increasingly identified in the geriatric population. Current literature shows varying outcomes with voice therapy. Our goal was to analyze multidimensional vocal outcomes of these patients who underwent voice therapy. Secondary aims included determining compliance and analyzing differences in patients who undergo surgery. Methods: 197 patients with vocal fold atrophy were included and reviewed. Patients were categorized by treatment received. Patient-reported, perceptual, aerodynamic, and acoustic voice outcomes were analyzed before and after therapeutic intervention. Changes were calculated and significance determined using Wilcoxon signed-rank and rank-sum tests. Results: 89(45%) received no therapy, 43(22%) incomplete therapy, 51(26%) complete therapy, 8(4%) surgery only, and 6(3%) therapy followed by surgery. Those who completed voice therapy showed significant improvement in voice related quality of life (VRQOL) ( P = .0225), glottal function index (GFI) ( P < .001), grade, roughness, breathiness, asthenia, strain (GRBAS) ( P < .001), maximum phonation time (MPT) ( P = .0081), and fundamental frequency in women ( P = .0024). No significant changes were found in mean airflow. When comparing patients who underwent surgery versus voice therapy, statistically significant differences were present between pre-treatment VRQOL ( P = .0269) and GFI ( P = .0166). Conclusions: Only 29% of patients with vocal atrophy completed voice therapy when recommended. Within this patient cohort, voice therapy results in significant improvement in multidimensional voice outcomes. Patients with vocal atrophy that undergo surgical treatment differ from those treated with voice therapy alone in their pre-treatment patient-reported measures.

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Update: Behavioral Management of Unilateral Vocal Fold Paralysis and Paresis

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_pers-sig3-2018-0018 ◽

2019 ◽

Vol 4 (3) ◽

pp. 474-482

Author(s):

Sarah L. Schneider

Keyword(s):

Vocal Fold ◽

Treatment Plan ◽

Traumatic Injury ◽

Voice Therapy ◽

Valuable Insight ◽

Behavioral Management ◽

Use Patterns ◽

Vocal Quality ◽

And Function ◽

Voice Use

PurposeVocal fold motion impairment (VFMI) can be the result of iatrogenic or traumatic injury or may be idiopathic in nature. It can result in glottic incompetence leading to changes in vocal quality and ease. Associated voice complaints may include breathiness, roughness, diplophonia, reduced vocal intensity, feeling out of breath with talking, and vocal fatigue with voice use. A comprehensive interprofessional voice evaluation includes auditory-perceptual voice evaluation, laryngeal examination including videostroboscopy, acoustic and aerodynamic voice measures. These components provide valuable insight into laryngeal structure and function and individual voice use patterns and, in conjunction with stimulability testing, help identify candidacy for voice therapy and choice of therapeutic techniques.ConclusionA comprehensive, interprofessional evaluation of patients with VFMI is necessary to assess the role of voice therapy and develop a treatment plan. Although there is no efficacy data to support specific voice therapy techniques for treating VFMI, considerations for various techniques are provided.

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Reduction in Short- and Long-term Pneumonia Rate With Laryngoplasty for Unilateral Vocal Fold Paralysis

Otolaryngology ◽

10.1177/01945998211015174 ◽

2021 ◽

pp. 019459982110151

Author(s):

Cheng-Ming Hsu ◽

Yao-Te Tsai ◽

Geng-He Chang ◽

Yao-Hsu Yang ◽

Tuan-Jen Fang ◽

...

Keyword(s):

Lower Incidence ◽

Vocal Fold ◽

Proportional Hazards ◽

Vocal Fold Paralysis ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Voice Therapy ◽

Unilateral Vocal Fold Paralysis ◽

Short And Long Term

Objective To examine the association of laryngoplasty, voice therapy, and pneumonia rate in patients with unilateral vocal fold paralysis (UVFP). Study Design Population-based retrospective cohort study. Setting Data were collected from the LHID2000 (Longitudinal Health Insurance Database 2000), containing the information of 1 million randomly selected patients in Taiwan. Methods In the LHID2000, we identified 439 patients having new diagnoses of UVFP from 1997 to 2013. We grouped the aforementioned patients according to UVFP treatment and probed the occurrence of pneumonia: 305 patients underwent laryngoplasty or voice therapy, and 134 patients did not undergo treatment. Follow-up procedures were executed for the enrollees until death or December 31, 2013, representing the end of the study period. We assessed the association of UVFP treatment and pneumonia by executing Cox proportional hazards regression. Results The pneumonia cumulative incidence was significantly higher among enrolled patients without treatment than in those receiving treatment ( P < .001). The pneumonia incidence was significantly lower in patients receiving UVFP treatment (hazard ratio, 0.49; 95% CI, 0.27-0.88; P = .018), as validated by the Cox proportional hazards model after adjustment. Patients undergoing laryngoplasty with or without voice therapy had a significantly lower incidence of pneumonia at 6 months and 1, 3, and 5 years, whereas those undergoing voice therapy alone did not. Conclusion Laryngoplasty was associated with a lower incidence of short- and long-term pneumonia in patients with UVFP. Physicians should encourage patients with UVFP at risk of aspiration to receive prompt evaluation as well as treatment.

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Effects of Voice Therapy as Objectively Evaluated by Digitized Laryngeal Stroboscopic Imaging

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940211101007 ◽

2002 ◽

Vol 111 (10) ◽

pp. 902-908 ◽

Cited By ~ 22

Author(s):

Renée Speyer ◽

Pieter A. Kempen ◽

George Wieneke ◽

Willem Kersing ◽

Elham Ghazi Hosseini ◽

...

Keyword(s):

Vocal Fold ◽

Vocal Folds ◽

Lesion Size ◽

Voice Therapy ◽

Benign Lesions ◽

Objective Measurements ◽

Significant Parameter ◽

Surface Areas ◽

Vocal Fold Vibration ◽

Maximal Opening

Objective measurements derived from digitized laryngeal stroboscopic images were used to demonstrate changes in vocal fold vibration and in the size of benign lesions after 3 months of voice therapy. Forty chronically dysphonic patients were studied. By means of a rigid stroboscope, pretreatment and posttreatment recordings were made of the vocal folds at rest and under stroboscopic light during phonation. From each recording, images of the positions at rest and during vibration at maximal opening and at maximal closure were digitized. The surface areas of any lesions and of the glottal gap were independently measured in the digitized images by 2 experienced laryngologists. Referential distances were determined in order to compensate for discrepancies in magnification in the various recordings. After 3 months of voice therapy, significant improvement in lesion size and degree of maximal closure during vibration could be demonstrated in about 50% of the patients. The degree of maximal opening did not prove to be a significant parameter.

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