Physical Therapy for Muscle Tension Dysphonia with Cervicalgia

Objectives This study investigated the effectiveness of a specialized manual physical therapy (PT) program at improving voice among patients diagnosed with concomitant muscle tension dysphonia (MTD) and cervicalgia at a tertiary care voice center. Materials and Methods Cervicalgia was determined by palpation of the anterior neck. Both voice therapy (VT) and PT was recommended for all patients diagnosed with MTD and cervicalgia. PT included full-body manual physical therapy with myofascial release. Patients underwent: 1) VT alone, 2) concurrent PT and VT (PT with VT), 3) PT alone, 4) VT, but did not have PT ordered by treating clinician (VT without PT order) or 5) VT followed by PT (VT then PT). The pairwise difference in post–Voice Handicap Index-10 (VHI-10) controlling for baseline variables was calculated with a linear regression model. Results 178 patients met criteria. All groups showed improvement with treatment. The covariate-adjusted differences in mean post–VHI-10 improvement comparing the VT alone group as a reference were as follows: PT with VT 9.95 (95% confidence interval 7.70, 12.20); PT alone 8.31 (6.16, 10.45); VT without PT order 8.51 (5.55, 11.47); VT then PT 5.47 (2.51, 8.42). Conclusion Among patients diagnosed with MTD with cervicalgia, treatment with a specialized PT program was associated with improvement in VHI-10 scores regardless of whether they had VT. While VT is the standard of care for MTD, PT may also offer benefit for MTD patients with cervicalgia.

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Comparative Evaluation and Management of Dysphonia Between Adults <65 and ≥65 Years of Age

Otolaryngology ◽

10.1177/0194599820978435 ◽

2020 ◽

pp. 019459982097843

Author(s):

Amy Jacks ◽

Hannah Kavookjian ◽

Shannon Kraft

Keyword(s):

Vocal Cord ◽

Laryngopharyngeal Reflux ◽

Tertiary Care ◽

Muscle Tension ◽

Voice Handicap Index ◽

Voice Therapy ◽

Old Patients ◽

Presenting Symptoms ◽

Muscle Tension Dysphonia ◽

Significant Relationships

Objective To compare presenting symptoms, etiology, and treatment outcomes among dysphonic adults <65 and ≥65 years of age. Study Design Retrospective cohort study. Setting Tertiary care voice center between January 2011 and June 2016. Methods A total of 755 patients presenting for dysphonia were included in the study: 513 adults <65 years of age and 242 adults ≥65. Data collected included demographics, referral information, prior diagnoses, prior treatments, clinical examination findings, diagnosis, coexisting symptoms, treatments, and pre- and postintervention Voice Handicap Index scores. Statistical analysis was performed with SPSS to determine significant relationships between variables of interest. Results The most common etiologies of dysphonia were vocal cord atrophy (44.8%) in the ≥65 cohort and benign vocal cord lesions (17.8%) in the <65 cohort. When compared with adults <65 years old, patients ≥65 had a higher incidence of neurologic dysphonia ( P = .006) and vocal cord atrophy ( P < .001) but were less likely to have laryngopharyngeal reflux ( P = .001), benign vocal cord lesions ( P < .001), or muscle tension dysphonia ( P < .001). Overall, 139 patients had surgery, 251 received medical therapy, and 156 underwent voice therapy. The ≥65 cohort demonstrated improvement in Voice Handicap Index scores after surgery ( P = .001) and voice therapy ( P = .034), as did the <65 cohort (surgery, P < .001; voice therapy, P = .015). Adult surgical patients <65 reported greater improvements than patients ≥65 ( P = .021). Conclusions There are notable differences in the pathophysiology of dysphonia between patients aged ≥65 and <65 years. Although adults <65 reported slightly better outcomes with surgery, patients ≥65 obtained significant benefit from surgery and voice therapy.

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Combining voice therapy and physical therapy: A novel approach to treating muscle tension dysphonia

Journal of Communication Disorders ◽

10.1016/j.jcomdis.2015.05.001 ◽

2015 ◽

Vol 58 ◽

pp. 169-178 ◽

Cited By ~ 22

Author(s):

Jennifer Craig ◽

Carey Tomlinson ◽

Kristin Stevens ◽

Kiran Kotagal ◽

Judith Fornadley ◽

...

Keyword(s):

Physical Therapy ◽

Muscle Tension ◽

Voice Therapy ◽

Muscle Tension Dysphonia ◽

Novel Approach

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Efficacy of Conversation Training Therapy for Patients With Benign Vocal Fold Lesions and Muscle Tension Dysphonia Compared to Historical Matched Control Patients

Journal of Speech Language and Hearing Research ◽

10.1044/2019_jslhr-s-19-0136 ◽

2019 ◽

Vol 62 (11) ◽

pp. 4062-4079 ◽

Cited By ~ 1

Author(s):

Amanda I. Gillespie ◽

Jonathan Yabes ◽

Clark A. Rosen ◽

Jackie L. Gartner-Schmidt

Keyword(s):

Muscle Tension ◽

Standard Of Care ◽

Voice Therapy ◽

Therapy Session ◽

Muscle Tension Dysphonia ◽

Benign Vocal Fold Lesions ◽

Long Term Follow Up ◽

Training Therapy

Purpose Conversation training therapy (CTT) is the 1st voice therapy approach to eliminate the traditional therapeutic hierarchy and use patient-driven conversation as the sole therapeutic stimulus. The purpose of this investigation was to determine the efficacy of CTT compared to standard-of-care voice therapy approaches for the treatment of patients with voice disorders. Method A prospective study of CTT treatment outcomes in adults with dysphonia due to primary muscle tension dysphonia or benign vocal fold lesions compared to age, gender, and diagnosis historical matched control (HMC) patients was used. The primary outcome was change in Voice Handicap Index–10 (VHI-10); secondary outcomes included acoustic, aerodynamic, and auditory-perceptual outcomes. Data were collected before treatment (baseline), at the start of each therapy session, 1 week after the final therapy session (short-term follow-up), and 3 months after the final therapy session (long-term follow-up). Results For the CTT group, statistically significant improvements were observed for VHI-10. Though statistically significant improvements were observed for the VHI-10 for the HMC group, the CTT group saw significantly greater improvement in VHI-10. Furthermore, equivalent gains were observed following only 2 sessions of CTT compared to 4–8 sessions of traditional therapy. Significant improvements in the CTT group were observed for cepstral peak prominence in a vowel, fundamental frequency, Cepstral Spectral Index of Dysphonia in a vowel and connected speech, vocal intensity, average airflow in speech in a reading passage, number of breaths and duration of reading passage, and auditory-perceptual measurement of overall voice severity. Conclusions Results support the hypothesis that training voice techniques in the context of spontaneous conversational speech improves patient perception of voice handicap and acoustic, aerodynamic, and auditory-perceptual voice outcomes both immediately following treatment and at long-term follow-up. CTT participants also demonstrated significantly larger decreases in VHI-10 compared to HMC participants who received standard-of-care, nonconversational, hierarchical-based voice therapy.

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Effects and Differences of Voice Therapy on Spasmodic Dysphonia and Muscle tension dysphonia: A Retrospective Pilot Study

Journal of Voice ◽

10.1016/j.jvoice.2021.07.003 ◽

2021 ◽

Author(s):

Narihiro Kodama ◽

Tetsuji Sanuki ◽

Takumi Miyamoto ◽

Joji Tashiro

Keyword(s):

Pilot Study ◽

Muscle Tension ◽

Voice Therapy ◽

Spasmodic Dysphonia ◽

Muscle Tension Dysphonia

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Intractable Muscle Tension Dysphonia Treated by Injection Laryngoplasty and Lidocaine Injection

Journal of The Korean Society of Laryngology Phoniatrics and Logopedics ◽

10.22469/jkslp.2021.32.2.94 ◽

2021 ◽

Vol 32 (2) ◽

pp. 94-97

Author(s):

You Young An ◽

Jun Yeong Jeong ◽

Ki Nam Park ◽

Seung Won Lee

Keyword(s):

Gold Standard ◽

Muscle Tension ◽

Voice Quality ◽

Laryngeal Nerve ◽

Voice Therapy ◽

Voice Disorder ◽

Injection Laryngoplasty ◽

Muscle Tension Dysphonia ◽

Lidocaine Injection ◽

Botox Injection

Muscle tension dysphonia (MTD) is a voice disorder characterized by excessive tension of the laryngeal muscles during phonation. Voice therapy is the gold standard of treatment for MTD. However, patients with MTD do not always respond to voice therapy. Multidisciplinary approaches have been attempted to treat intractable MTD such as lidocaine instillation, lidocaine injection to recurrent laryngeal nerve, botox injection and excision of false ventricle using CO2 laser. Recently, injection laryngoplasty is suggested that assists in more efficient phonation and voice therapy to MTD patients. A patient with intractable MTD underwent lidocaine injection and injection laryngoplasty showed improved voice quality and remained stable until postoperative 3 months without any complications.

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Presbylarynx, Functional Voice Disorders, Muscle Tension Dysphonia

10.2310/ot.7065 ◽

2021 ◽

Author(s):

Elizabeth Erickson-DiRenzo ◽

Christine M. Kim ◽

C. Kwang Sung Sung

Keyword(s):

Muscle Tension ◽

Voice Disorders ◽

Neuromuscular Control ◽

Vocal Folds ◽

Voice Therapy ◽

Type I ◽

Muscle Tension Dysphonia ◽

Functional Dysphonia ◽

Age Related ◽

Type I Thyroplasty

Presbylarynx refers to age-related structural changes of the vocal folds that include muscle atrophy, reduced neuromuscular control, loss of superficial lamina propria layer, and reduced pliability. The changes result in thin and bowed vocal folds, increased vocal effort requirements, breathy voice, change in habitual pitch, and strain. The primary treatment options are voice therapy focused on strengthening breath support and the intrinsic muscles of the larynx, and optimization of resonance; injection augmentation of the vocal folds; and type I thyroplasty. Functional dysphonia is defined as change in voice quality in the absence of structural or neurological abnormalities of the larynx. Muscle tension dysphonia (MTD) is a subtype of functional voice disorders and involves laryngeal muscle tension imbalance due to excessive or dysregulated activation resulting often in strained or breathy voice. MTD can be divided into primary (psychological etiology or vocal misuse) and secondary (compensatory for organic laryngeal pathology). The mainstay of treatment for MTD is voice therapy, along with medical or surgical treatment of the underlying vocal pathology in secondary MTD. Mutational falsetto, or puberphonia, is a functional voice disorder where a high-pitched, pre-adolescent voice fails to transition to the lower pitch of adulthood. This review contains 5 figures, 7 tables, 4 videos and 10 references Key Words: Presbylarynx, Injection augmentation, Type I thyroplasty, Primary muscle tension dysphonia, Secondary muscle tension dysphonia, Muscle tension patterns, Manual circumlaryngeal therapy, Functional dysphonia, Mutational falsetto

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