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

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.

Physical Therapy for Muscle Tension Dysphonia with Cervicalgia

2021 ◽  
pp. 014556132110632
Author(s):  
Alan D Tate ◽  
Carey A Tomlinson ◽  
David Oliver Francis ◽  
Emily D Wishik ◽  
Anne S Lowery ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Confidence Interval ◽  
Tertiary Care ◽  
Muscle Tension ◽  
Standard Of Care ◽  
Voice Therapy ◽  
Anterior Neck ◽  
Myofascial Release ◽  
Muscle Tension Dysphonia ◽  
Full Body

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.

scholarly journals Voice Therapy in Muscle Tension Dysphonia Cases

2015 ◽  
Vol 5 (1) ◽  
pp. 20-24
Author(s):  
Smrity Rupa Borah Dutta
Keyword(s):  
Treatment Approach ◽  
Laryngopharyngeal Reflux ◽  
Muscle Tension ◽  
Professional Life ◽  
Voice Therapy ◽  
Medical College ◽  
Muscle Tension Dysphonia ◽  
Vocal Polyp ◽  
Muscular Tension ◽  
Post Therapy

ABSTRACT Muscle tension dysphonia (MTD) is a condition where phonation is associated with excessive muscular tension or muscle misuse. It has multifactorial etiologies. It can be a primary or secondary MTD. While it can affect anyone, sufferers usually belong to a particular group. It has very serious impact on sufferer's personal, social and professional life. We are presenting here, our 20 months prospective study done in the department of otorhinolaryngology, Silchar Medical College and Hospital from June 2012 to July 2013. Voice therapy was given to every patient, whether primary or secondary MTD. Pre-therapy vs post-therapy comparisons were made of self-ratings of voice handicap index, auditoryperceptual ratings as well as visual-perceptual evaluations of laryngeal images. Outcome of voice therapy results (Graphs 1 and 2) in such patients were found to be very good. As the disease is multifactorial, treatment approach should be broad-based involving multidisciplinary team. Abbreviations Vocal Cord Nodule (N), Vocal Polyp (P), Laryngopharyngeal Reflux (LPR), Presbylaryngis (PL), Cut Throat injury (CT), Primary Muscle Tension Dysphonia (PMTD), Dysphonia Plica ventricular (DPV). How to cite this article Singh SP, Dutta SRB. Voice Therapy in Muscle Tension Dysphonia Cases. Int J Phonosurg Laryngol 2015;5(1):20-24.

Voice Therapy for Benign Voice Disorders in the Elderly: A Randomized Controlled Trial Comparing Telepractice and Conventional Face-to-Face Therapy

2020 ◽  
Vol 63 (7) ◽  
pp. 2132-2140
Author(s):  
Feng-Chuan Lin ◽  
Hsin-Yu Chien ◽  
Sheng Hwa Chen ◽  
Yi-Chia Kao ◽  
Po-Wen Cheng ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Elderly Patients ◽  
Controlled Trial ◽  
Muscle Tension ◽  
Voice Disorders ◽  
Voice Handicap Index ◽  
Voice Therapy ◽  
Perceptual Evaluation ◽  
Muscle Tension Dysphonia ◽  
Randomized Controlled

Purpose Previous studies have reported that voice therapy via telepractice is useful for patients with nodules and muscle tension dysphonia. Nevertheless, telepractice for elderly patients with voice disorders has not yet been investigated. We conducted this study to examine the hypothesis that voice therapy via telepractice is not inferior to conventional voice therapy. Method Eighty patients with dysphonia aged more than 55 years participated in this study from September 2016 to June 2018. After screening the inclusion and the exclusion criteria, 69 patients were randomized into telepractice (33 patients) and conventional (36 patients) groups. The outcome measurements included Voice Handicap Index-10, videolaryngostroboscopy, maximum phonation time, auditory-perceptual evaluation, and acoustic analysis. Paired t test, Wilcoxon signed-ranks test, and repeated measures analysis of variance were used to examine treatment outcomes. Results The diagnoses of voice disorders included atrophy ( n = 33), unilateral vocal paralysis ( n = 13), muscle tension dysphonia ( n = 7), nodules ( n = 6), and polyps ( n = 10). No significant differences were observed in age, sex, and baseline measurements between the two groups. Twenty-five patients in the telepractice group and 24 patients in the control group completed at least four weekly sessions. Significant improvements were observed for all the outcome measures ( p < .05) in both groups. Improvements in Voice Handicap Index-10 in the telepractice group (24.84 ± 5.49 to 16.80 ± 8.94) were comparable to those in the conventional group (22.17 ± 7.29 to 13.46 ± 9.95, p = .764). Other parameters also showed comparable improvements between the two groups without statistically significant differences. Conclusions This is the first randomized controlled trial comparing telepractice and conventional voice therapy in elderly patients with voice disorders. The results showed that the effectiveness of voice therapy via telepractice was not inferior to that of conventional voice therapy, indicating that telepractice can be used as an alternative to provide voice care for elderly patients with vocal disorders.

Medialization Laryngoplasty in the Elderly: Outcomes and Expectations

2017 ◽  
Vol 157 (4) ◽  
pp. 664-669 ◽  
Author(s):  
Andrew Jay Bowen ◽  
Tiffany L. Huang ◽  
Michael S. Benninger ◽  
Paul C. Bryson
Keyword(s):  
Elderly Patients ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Tertiary Care ◽  
Anticoagulation Therapy ◽  
Voice Handicap Index ◽  
Care Hospital ◽  
Disease Etiology ◽  
Chi Square Analysis ◽  
Medialization Laryngoplasty

Objective To describe the profile and outcomes of elderly patients undergoing medialization laryngoplasty for vocal cord paralysis. Study Design Case series with retrospective review. Setting Tertiary care hospital. Subjects and Methods Patients were included in the study if they were >65 years old at the time of medialization laryngoplasty between 2008 and 2015. Patient comorbidities, anticoagulation status, disease etiology, and physical examination findings were recorded with postoperative length of stay, complications, pre- and posttreatment voice outcomes with the Voice Handicap Index (at 6 weeks, 4 months, 8 months, and 1 year), and postprocedural interventions (revision injections, surgery, therapy). Results A total of 112 patients met the eligibility criteria. Iatrogenic injury to the recurrent laryngeal nerve (50%) was the most common etiology, followed by idiopathic (31%) causes. Sixty percent of patients were receiving long-term antiplatelet and/or anticoagulation therapy. All but 14 patients on aspirin therapy stopped their antiplatelet/anticoagulation therapy prior to surgery. Most patients were discharged on the day of surgery. Postprocedure Voice Handicap Index scores significantly improved ( P < .001) by 47%, 53%, 64%, and 57% at each of the 4 measured postprocedure dates, respectively. Two patients had major nonsurgical complications postoperatively requiring inpatient hospitalization. Chi-square analysis revealed no differences between intraoperative aspirin use, sex, or comorbidities and the incidence of complications ( P > .05). Conclusion The clinical profile and outcomes of our patients undergoing medialization laryngoplasty are comparable to those seen in younger cohorts. Medialization laryngoplasty is a safe and successful option for elderly patients with vocal cord paralysis and vocal handicap.

scholarly journals Intractable Muscle Tension Dysphonia Treated by Injection Laryngoplasty and Lidocaine Injection

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.

Presbylarynx, Functional Voice Disorders, Muscle Tension Dysphonia

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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