Update: Behavioral Management of Unilateral Vocal Fold Paralysis and Paresis

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.

Behavioral Management of Unilateral Vocal Fold Paralysis and Paresis

2012 ◽  
Vol 22 (3) ◽  
pp. 112-120 ◽  
Author(s):  
Sarah L. Schneider
Keyword(s):  
Clinical Experience ◽  
Vocal Fold ◽  
Therapeutic Process ◽  
Vocal Fold Paralysis ◽  
Voice Therapy ◽  
Diagnostic Tools ◽  
Unilateral Vocal Fold Paralysis ◽  
Behavioral Management ◽  
Efficacy Data ◽  
Treatment Techniques

Purpose: In this article, I will summarize the process of selecting appropriate voice therapy candidates and relevant treatment techniques for patients with unilateral vocal fold paralysis or paresis. Methods: I will present a review of the literature and pertinent clinical experience while laying out diagnostic tools, considerations for choosing voice therapy candidates, and specific therapy techniques that clinicians may employ. In addition, I highlight how these decisions are guided by a thorough behavioral diagnostic voice evaluation. Results: There are a number of publications in the literature that discuss the role of voice therapy and the types of voice therapy techniques commonly used in treating vocal fold motion impairment. However, little efficacy data exist about the utility of voice therapy alone in this population. Conclusions: Behavioral management of patients with vocal fold paralysis and paresis is widely accepted as part of the treatment process. With little efficacy data to support outcomes for specific voice therapy techniques alone with this patient population, we must continue to rely primarily on our clinical experience and outcomes from other populations to guide the therapeutic process.

scholarly journals Changes in a Daily Phonotrauma Index After Laryngeal Surgery and Voice Therapy: Implications for the Role of Daily Voice Use in the Etiology and Pathophysiology of Phonotraumatic Vocal Hyperfunction

2020 ◽  
Vol 63 (12) ◽  
pp. 3934-3944
Author(s):  
Jarrad H. Van Stan ◽  
Daryush D. Mehta ◽  
Andrew J. Ortiz ◽  
James A. Burns ◽  
Katherine L. Marks ◽  
...  
Keyword(s):  
Patient Group ◽  
Vocal Fold ◽  
Second Harmonic ◽  
Voice Therapy ◽  
Laryngeal Surgery ◽  
Vocal Hyperfunction ◽  
The Difference ◽  
Two Parameters ◽  
Voice Use

Purpose This study attempts to gain insights into the role of daily voice use in the etiology and pathophysiology of phonotraumatic vocal hyperfunction (PVH) by applying a logistic regression-based daily phonotrauma index (DPI) to predict group-based improvements in patients with PVH after laryngeal surgery and/or postsurgical voice therapy. Method A custom-designed ambulatory voice monitor was used to collect 1 week of pre- and postsurgery data from 27 female patients with PVH; 13 of these patients were also monitored after postsurgical voice therapy. Normative weeklong data were obtained from 27 matched controls. Each week was represented by the DPI, standard deviation of the difference between the first and second harmonic amplitudes (H1–H2). Results Compared to pretreatment, the DPI significantly decreased in the patient group after surgery (Cohen's d effect size = −0.86) and voice therapy ( d = −1.06). The patient group DPI only normalized after voice therapy. Conclusions The DPI produced the expected pattern of improved ambulatory voice use across laryngeal surgery and postsurgical voice therapy in a group of patients with PVH. The results were interpreted as providing new objective information about the role of daily voice use in the etiology and pathophysiology of PVH. The DPI is viewed as an estimate of potential vocal fold trauma that relies on combining the long-term distributional characteristics of two parameters representing the magnitude of phonatory forces (neck-surface acceleration magnitude) and vocal fold closure dynamics (H1–H2). Further validation of the DPI is needed to better understand its potential clinical use.

Role of Voice Therapy in Adherence to Voice Rest After Office-Based Vocal Fold Procedures

2021 ◽  
pp. 1-12
Author(s):  
Renee E. King ◽  
Seth H. Dailey ◽  
Susan L. Thibeault
Keyword(s):  
Vocal Fold ◽  
Therapy Group ◽  
Voice Therapy ◽  
Visual Analog Scales ◽  
Counseling Group ◽  
Evaluation Group ◽  
Before And After ◽  
Language Pathology ◽  
Voice Use

Purpose Patients undergoing vocal fold procedures significantly reduce but often do not cease voice use during absolute postprocedure voice rest. We hypothesized that patients who completed preprocedure voice therapy would increase adherence to postprocedure voice rest. Method Eighty-six participants completed this prospective cohort study. Patients scheduled for office-based vocal fold procedures, 1–3 days of absolute postprocedure voice rest, and preprocedure speech-language pathology (SLP) care were recruited. SLP care consisted of either (a) multiple voice therapy sessions, (b) one counseling/therapy session, or (c) voice evaluation only. Participants reported talking and other specific voice behaviors on 100-mm visual analog scales for up to 3 days pre- and postprocedure as well as changes in overall voice use at follow-up at least 1 week postprocedure. Results Talking decreased postprocedure by 63% in the therapy group and 65% in the counseling group, both significantly more than the 35% decrease measured in the evaluation group. There were group differences in talking at baseline but not during voice rest. Coughing and throat clearing were highest in the voice evaluation group and decreased less than talking during voice rest. At follow-up, 84% of participants reported that they completed voice rest for at least as long as recommended and 39.5% reported that they never used their voices during voice rest. Participants estimated a 98% overall reduction in voice use during voice rest at follow-up. Conclusions Voice use before and after vocal fold procedures varies by participation in preprocedure voice therapy. Patients significantly decrease talking during postprocedure voice rest but are not perfectly adherent. Communicative voice use decreases more than noncommunicative voice use during voice rest. Patients may overestimate adherence to voice rest at follow-up. Supplemental Material https://doi.org/10.23641/asha.16589864

scholarly journals Maximum and Minimum Phonatory Glottal Area before and after Treatment for Vocal Nodules

Healthcare ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 326
Author(s):  
Cheng-Ming Hsu ◽  
Ming-Yu Yang ◽  
Tuan-Jen Fang ◽  
Ching-Yuan Wu ◽  
Yao-Te Tsai ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Waveform Analysis ◽  
Voice Therapy ◽  
Maximum Phonation Time ◽  
Vocal Fold Vibration ◽  
Before And After ◽  
Vocal Nodules ◽  
Imagej Software ◽  
And Function ◽  
Vocal Fold Nodules

Background: Vocal fold nodules (VFNs) are a challenge for otolaryngologists. Glottal area (GA) waveform analysis is an examination method used for assessing vocal fold vibration and function. However, GA in patients with VFNs has rarely been studied. This study investigated the maximum and minimum GA in VFN patients using modern waveform analysis combining ImageJ software and videostroboscopy. Methods: This study enrolled 42 patients newly diagnosed with VFN, 15 of whom received voice therapy and 27 of whom underwent surgery. Acoustic parameters and maximum phonation time (MPT) were recorded, and patients completed the Chinese Voice Handicap Index-10 (VHI-C10) before and after treatment. After videostroboscopy examination, the maximum and minimum GAs were calculated using ImageJ software. The GAs of patients with VFNs before and after surgery or voice therapy were analyzed. Results: The MPTs of the patients before and after voice therapy or surgery did not change significantly. VHI-C10 scores decreased after voice therapy but the decrease was nonsignificant (14.0 ± 8.44 vs. 9.40 ± 10.24, p = 0.222); VHI-C10 scores were significantly decreased after surgery (22.53 ± 7.17 vs. 12.75 ± 9.84, p = 0.038). Voice therapy significantly increased the maximum GA (5.58 ± 2.41 vs. 8.65 ± 3.17, p = 0.012) and nonsignificantly decreased the minimum GA (0.60 ± 0.73 vs. 0.21 ± 0.46, p = 0.098). Surgery nonsignificantly increased the maximum GA (6.34 ± 3.82 vs. 8.73 ± 5.57, p = 0.118) and significantly decreased the minimum GA (0.30 ± 0.59 vs. 0.00 ± 0.00, p = 0.036). Conclusion: This study investigated the GA of patients with VFNs who received voice therapy or surgery. The findings indicated that voice therapy significantly increased maximum GA and surgery significantly decreased minimum GA. GA analysis could be applied to evaluate the efficacy of voice therapy, and it may help physicians to develop precise treatment for VFN patients (either by optimizing voice therapy or by performing surgery directly).

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

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.

Cordectomy: a solution to Teflon granuloma of the vocal fold

1995 ◽  
Vol 109 (1) ◽  
pp. 53-55 ◽  
Author(s):  
J. D. Russell ◽  
Alison Perry ◽  
A. D. Cheesman
Keyword(s):  
Surgical Approach ◽  
Vocal Fold ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis ◽  
Vocal Quality ◽  
Teflon Granuloma

AbstractTeflon injection has been widely used for the treatment of unilateral vocal fold paralysis. Complications are few and infrequent. Overinjection and Teflon granuloma are the two commonest problems encountered. Treating such complications and restoring vocal quality is widely regarded as difficult. Endoscopic transmucosal excision of the excess Teflon and/or granuloma has not been successful in improving phonatory quality. Cordectomy is proposed as an alternative surgical approach for managing both the convex vocal fold and Teflon granuloma after injection.

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

2002 ◽  
Vol 111 (10) ◽  
pp. 902-908 ◽  
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.

scholarly journals Root Development of Permanent Incisors and Mandibular Molars in Correlation with Treatment Plan

Folia Medica ◽  
2018 ◽  
Vol 60 (2) ◽  
pp. 283-290
Author(s):  
Yordan Tarpomanov ◽  
Sevda Rimalovska ◽  
Ani Belcheva ◽  
Miroslava Yordanova ◽  
Svetla Yordanova ◽  
...  
Keyword(s):  
Root Development ◽  
Treatment Plan ◽  
X Rays ◽  
Proper Treatment ◽  
Treatment Protocols ◽  
Mandibular Molars ◽  
Dental Practitioners ◽  
Open Apices ◽  
And Function ◽  
Demirjian’S Method

Abstract Background: The incisors and molars play a major role in the formation and function of permanent dentition. Much research has been devoted to investigating the eruption of teeth and their root development. Aim: To study the root development of permanent incisors and mandibular molars in correlation with treatment plan and proper treatment protocols. Materials and methods: The Demirjian’s method was used to assess the root development of incisors and mandibular molars in children between 7 and 12 years old. Results: In 7-year-old children most of the lower first mandibular molars (76%) had complete root length, but open apices. Eighty-two percent of the roots of the first mandibular molars of the 8-year-old children and 54% of these molars of the 9-year-old children were with open apices. The first mandibular molars had incomplete roots in the 10-year-olds (6%) and even in the 11-year-old children (4%). We detected Stage E in 32% of the 10-year-olds and in 24% of the 11-year-old children. Even in 12-year-old children we found Stage E in 4% of them from their panoramic X-rays. We detected complete root development in all of the children at the age of 12. Conclusions: Dental practitioners have to wait until the age of 10, 11 and even 12 to extract the first molars, when the furcation is formed. Proper clinical examination and diagnostic radiographs should be done before the beginning of the treatment of molars and incisors at the age between 7 and 12.

scholarly journals Importance of Diagnostic Waxing in Oral Rehabilitation: Case Report

2020 ◽  
Vol 22 (2) ◽  
pp. 146-150
Author(s):  
Mariana Lima da Costa Valente ◽  
Marcela Silva Costa ◽  
Paulo Marcos Bérgamo ◽  
Denise Tornavoi de Castro
Keyword(s):  
Quality Of Life ◽  
Treatment Plan ◽  
Dental Restoration ◽  
Oral Rehabilitation ◽  
Correct Treatment ◽  
Life Planning ◽  
End Of Treatment ◽  
Patient Reported ◽  
And Function

Currently, aesthetics, and especially the smile, adds considerable social value. In this way, patients suffering from dental loss wish that their rehabilitation be performed quickly and safely. The aim of oral rehabilitation is to restore masticatory, phonetic, aesthetic and quality of life to the patient. The diagnostic step is one of the most important and relevant steps in establishing a correct treatment plan and, in this way, it is possible to obtain excellent results. The present study aimed to demonstrate the importance of diagnostic waxing in oral rehabilitation. Patient sought treatment at the Dental Prosthesis Specialization Course at Odonto School, due to complaints associated with aesthetics and function. To improve their quality of life, planning of case was carried out through diagnostic waxing and a prosthetic solution was proposed. At the end of treatment and during the follow-up of the case, the patient reported satisfaction and significant improvement in quality of life. It can be concluded that the diagnostic waxing presents customized solutions offering, through a previous study, an effective clinical resolution to the patient. Keywords: Mouth Rehabilitation. Dental Restoration, Temporary. Dental Restoration, Temporary. Resumo Atualmente, a estética, e em especial o sorriso, agregam um valor social considerável. Dessa forma, ao sofrerem a perda dental, os pacientes desejam que sua reabilitação seja realizada de forma rápida e segura. A reabilitação oral tem como objetivo devolver ao paciente a eficiência mastigatória, fonética, estética e a qualidade de vida. A etapa diagnóstica constitui um dos passos mais importantes e relevantes no estabelecimento de um correto planejamento do tratamento e, desta forma, torna-se possível obter resultados de excelência. O presente estudo teve como objetivo demonstrar a importância do enceramento diagnóstico na reabilitação oral. Paciente procurou tratamento no Curso de Especialização em Prótese Dentária da Odonto School, devido a queixas associadas a estética e função. Para melhorar sua qualidade de vida, foi realizado o planejamento do caso por meio do enceramento diagnóstico e uma solução protética foi proposta. Ao final do tratamento e durante o acompanhamento do caso, a paciente relatou satisfação e melhora significativa na qualidade de vida. Pode-se concluir que o enceramento diagnóstico apresenta soluções personalizadas oferecendo, por meio de estudo prévio, uma resolução clínica efetiva ao paciente. Palavras-chave: Reabilitação Bucal. Restauração Dentária Temporária. Prótese Dentária Temporária.

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