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

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.

Unilateral transverse cordotomy for bilateral abductor vocal fold immobility

2012 ◽  
Vol 126 (9) ◽  
pp. 913-917 ◽  
Author(s):  
J M Bernstein ◽  
S M Jones ◽  
P H Jones
Keyword(s):  
Vocal Fold ◽  
Case Series ◽  
University Hospital ◽  
Symptom Scale ◽  
Voice Change ◽  
Airway Function ◽  
Scale Scores ◽  
Before And After ◽  
Vocal Fold Immobility

AbstractObjective:We present a case series with airway compromise due to bilateral abductor vocal fold paralysis or fixation, treated with unilateral transverse cordotomy.Methods:Of eight consecutive patients with dyspnoea due to bilateral paramedian vocal fold immobility, seven underwent unilateral transverse cordotomy between August 2006 and April 2010 at University Hospital of South Manchester, UK. Airway and voice outcomes were compared before and after surgery.Results:All seven treated cases derived subjective airway function improvement; there was no aspiration. The eighth case had inadequate access. None of the seven treated patients required contralateral cordotomy or permanent tracheostomy. One treated case required a temporary tracheostomy; unilateral transverse cordotomy facilitated eventual decannulation. Two patients died of cancer at five and six weeks, variously. At a mean follow up of 22 months, four cases showed unchanged or slightly worse Voice Symptom Scale and Grade-Roughness-Breathiness-Asthenia-Strain scale scores.Conclusion:In patients with bilateral abductor vocal fold immobility, unilateral transverse cordotomy results in improved dyspnoea with either no voice change or only slight worsening. This is a more conservative procedure than bilateral transverse cordotomy, with the potential for better preservation of voice and breath support.

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.

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).

scholarly journals Telepractice Versus In-Person Delivery of Voice Therapy for Primary Muscle Tension Dysphonia

2015 ◽  
Vol 24 (3) ◽  
pp. 386-399 ◽  
Author(s):  
Balaji Rangarathnam ◽  
Gary H. McCullough ◽  
Hylan Pickett ◽  
Richard I. Zraick ◽  
Ozlem Tulunay-Ugur ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Behavioral Treatment ◽  
Statistical Significance ◽  
Muscle Tension ◽  
Voice Therapy ◽  
Muscle Tension Dysphonia ◽  
Quality Of Life Measures ◽  
Before And After ◽  
Language Pathology

Purpose The purpose of this study was to investigate the utility of telepractice for delivering flow phonation exercises to persons with primary muscle tension dysphonia (MTD). Method Fourteen participants with a diagnosis of primary MTD participated, 7 on site and 7 at remote locations. Each participant received 12 treatment sessions across 6 weeks. Treatment consisted of flow phonation voice therapy exercises. Auditory–perceptual, acoustic, aerodynamic, and quality-of-life measures were taken before and after treatment. Results Perceptual and quality-of-life measures were significantly better posttreatment and were statistically equivalent across groups. Acoustic and aerodynamic measures improved in both groups, but changes did not reach statistical significance. Results for the 2 service delivery groups were comparable, with no significant differences observed for perceptual and quality-of-life measures. Conclusions Although the American Speech-Language-Hearing Association supports the use of telepractice for speech-language pathology services, evidence for the use of telepractice for providing behavioral treatment to patients with MTD has been lacking. The results of this study indicate that flow phonation exercises can be successfully used for patients with MTD using telepractice.

scholarly journals Dysphonia secondary to traumatic avulsion of the vocal fold in infants

2010 ◽  
Vol 124 (11) ◽  
pp. 1229-1233 ◽  
Author(s):  
D Bray ◽  
L Cavalli ◽  
N Eze ◽  
N Mills ◽  
B E J Hartley
Keyword(s):  
World Literature ◽  
Vocal Fold ◽  
Injury Risk ◽  
Case Series ◽  
Voice Therapy ◽  
Street Hospital ◽  
Great Ormond Street Hospital ◽  
Injury Risk Factors ◽  
The Voice

AbstractObjective:Airway compromise due to paediatric intubation injuries is well documented; however, intubation injuries may also cause severe voice disorders. We report our experience and review the world literature on the voice effects of traumatic paediatric intubation.Case series:We report five cases of children referred to Great Ormond Street Hospital for Children who suffered traumatic avulsion of the vocal fold at the time of, or secondary to, endotracheal intubation. All children had significant dysphonia and underwent specialist voice therapy.Conclusions:The mechanisms of injury, risk factors and management of the condition are discussed. Children suffering traumatic intubation require follow up throughout childhood and beyond puberty as their vocal needs and abilities change. At the time of writing, none of the reported patients had yet undergone reconstructive or medialisation surgery. However, regular specialist voice therapy evaluation is recommended for such patients, with consideration of phonosurgical techniques including injection laryngoplasty or thyroplasty.

scholarly journals Unilateral Vocal Fold Paralysis and Voice Therapy: Does Age Matter? A Prospective Study With 100 Consecutive Patients

2019 ◽  
pp. 014556131988211 ◽  
Author(s):  
Mariline Santos ◽  
Susana Vaz Freitas ◽  
Pedro Santos ◽  
Isabel Carvalho ◽  
Miguel Coutinho ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Cross Sectional Study ◽  
Vocal Fold Paralysis ◽  
Voice Therapy ◽  
Unilateral Vocal Fold Paralysis ◽  
Self Assessment ◽  
Cross Sectional ◽  
Recent Onset ◽  
Before And After ◽  
A Prospective Study

Objective: To use a multidimensional assessment to analyze potential influence of “aging” in the functional outcomes achieved by a group of patients with recent onset of unilateral vocal fold paralysis (UVFP) who underwent voice therapy. Design: Prospective, observational, and cross-sectional study. Setting: Otolaryngology department, Centro Hospitalar do Porto. Participants: Patients with UVFP who underwent voice therapy. Main Outcome Measures: Data regarding gender, age, side and position of the paralyzed vocal fold, etiology, comorbidities, and Voice Handicap Index (VHI)—30 questions, before and after voice therapy, were collected. Glottal insufficiency was also evaluated, by endoscopic laryngoscopy, before and after voice therapy. Results: A total of 100 patients (76 females and 24 males) with UVFP were included. Mean age was 61.04 years (range: 21-88 years). The mean score of VHI, before and after voice therapy, was statistically different ( P < .001) with a lower score after therapy. The score of VHI was not influenced by age ( P = .717). However, for each 10-year increase in age, the score of VHI, before and after voice therapy, increased 1.91 and 2.86 units, respectively. As concerns endoscopic findings, 80% of patients exhibited better glottis closure after voice therapy ( P < .001), and this was not influenced by age. Nevertheless, for each 10-year increase in age, the chance of endoscopic improvement reduced 3%. Conclusions: A clear and significant improvement was visible in the endoscopic and self-assessment ratings after rehabilitation by isolated voice therapy. Despite possible anatomical and physiological aging changes in the phonatory system, age did not compromise the successful rate obtained by voice therapy.

Does Voice Therapy Improve Vocal Outcomes in Vocal Fold Atrophy?

2020 ◽  
pp. 000348942095246
Author(s):  
Emma Bick ◽  
Lukas D. Dumberger ◽  
Douglas R. Farquhar ◽  
Heather Davis ◽  
Elizabeth Ramsey ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Voice Therapy ◽  
Geriatric Population ◽  
Maximum Phonation Time ◽  
Patient Reported ◽  
Before And After ◽  
Related Quality ◽  
Vocal Fold Atrophy ◽  
Pre Treatment ◽  
Patient Reported Measures

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.

Management of Unilateral Vocal Fold Paralysis/Paresis: A Laryngologist's Perspective

2012 ◽  
Vol 22 (3) ◽  
pp. 121-130
Author(s):  
Mark Courey
Keyword(s):  
Vocal Fold ◽  
Vocal Fold Paralysis ◽  
Unilateral Vocal Fold Paralysis ◽  
Speech Language Pathology ◽  
Management Options ◽  
Vocal Fold Paresis ◽  
University Of Utah ◽  
Additional Information ◽  
Language Pathology

This manuscript is a follow up to a panel presentation on “Vocal Fold Paresis & Paralysis: Controversies in Evaluation & Management,” which was held during the 2011 American Speech-Language-Hearing Association (ASHA) Convention in San Diego, California. In addition to me, the other members of the panel included Sarah L. Schneider, MS, CCC-SLP, Director, Speech-Language Pathology Service, UCSF Voice and Swallowing Center; Nelson Roy, PhD, Professor, Speech & Language Pathology, Department of Communication Sciences & Disorders, University of Utah; and Marshall Smith, MD, Professor of Otolaryngology, Department of Surgery, University of Utah. During the panel, I was tasked with presenting the reasons for controversies in the diagnosis and management of vocal fold paralysis. In this manuscript, I will summarize my portion of that presentation and will provide additional information on management options for unilateral vocal fold paralysis (UVFP) from the perspective of a laryngologist.

scholarly journals Bilateral Vocal Fold Granuloma and Anterior Glottic Web After Papilloma Excision

2021 ◽  
pp. 014556132110121
Author(s):  
Benjamin T. Ostrander ◽  
Vanessa Yu ◽  
Andrew Vahabzadeh-Hagh
Keyword(s):  
Laser Ablation ◽  
Vocal Cord ◽  
Vocal Fold ◽  
Steroid Injection ◽  
Recurrent Respiratory Papillomatosis ◽  
Voice Therapy ◽  
Vocal Process ◽  
Co2 Laser Ablation ◽  
Anterior Glottic Web

We present a case of delayed vocal process granulomas and anterior glottic web after treatment of vocal fold papillomas with a laryngeal microdebrider and CO2 laser ablation. This case highlights a risk of vocal fold granuloma in the setting of recurrent respiratory papillomatosis and microdebrider use, warranting close follow-up and consideration of prophylactic voice therapy, anti-reflux medications, and steroid injection in cases of violation of vocal cord epithelium.

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