Predictive Factors for the Efficacy of Voice Therapy for Pediatric Vocal Fold Nodule

Background and Objectives Voice therapy (VT) is considered to be the gold standard of treatment of vocal fold nodule in children. This study was designed to analyze the success rate of pediatric VT and investigate the predictive factors for good response of periatic VT for vocal fold nodule.Materials and Method This was a retrospective cohort study of 23 patients under 18 years old who were diagnosed with vocal fold nodule and received pediatric VT. We divided the patients into responding and non-responding groups. We analyzed clinical and voice parameters related to the voice results.Results Twelve patients showed improved findings after VT. By univariate analysis, female patients (85.7%) and adolescence children (100%) showed a good response to VT. In multivariate analysis, female sex (p<0.05) and adolescence children (p<0.05) were significantly related to a successful voice response. Proton pump inhibitor or antihistamine, mucolytics treatment and pre-VT voice parameters did not significantly influence voice outcomes.Conclusion Pediatric VT is more effective in female and adolescence children.

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.

Singing Voice Therapy Revisited

Introduction. Singing is a type of sportive activity and, like sports medicine, professional voice medicine is interested in the habilitation and rehabilitation of the vocal performer. The vocal needs of the professional vocal performer may not be similar to other professional or non-professional voice users. Like a professional athlete, a vocal performer’s ability to perform for many decades at a high level will be enhanced by basing artistic and lifestyle decisions on a scientifically sound foundation. Objective. The aim of this study is to present a multidimensional introduction to the methods of SVT, incorporating the principles of sport and exercise medicine, and physical therapy and rehabilitation. Reflection. Singing voice therapy needs to provide answers to “what”, “why”, “how”, and “when” questions. SVT must first correctly identify the problem, leading to the “how to do” solutions for a wide variety of cases, followed by a schedule of prescribed activities including answers to the “why” question (which exercise relates to which muscle). The periodization and motor learning principles provide a temporal answer to the “when” question when developing habilitation and/or rehabilitative protocols. Conclusion. Singing is not only an artistic expression, but also a sportive performance. The clinical approach to professional voice is a multidimensional and multi-layered team effort. All practices are structured by blending scientific and pedagogical knowledge.

Effect of Intensive Voice Therapy in a Patient With Multiple System Atrophy

Introduction: Multiple System Atrophy (MSA) is a degenerative neurogenic disorder characterized by multiple symptoms affecting the movements and autonomic nervous system. It reduces the function of various types of nerve cells in the brain and spinal cord. MSA causes some movement disorders such as dysarthria that is one of the most common symptoms in these patients. The first neurological sign that sometimes progresses is the complete inability to produce speech. This study aimed to evaluate the effect of an intensive voice therapy based on the principles of Lee Silverman Voice Therapy (LSVT) on improving acoustic features, intelligibility, and quality of life index of the patients with MSA. Materials and Methods: The patient was a 57-year-old woman with MSA disorder. Acoustic assessments of voice, intelligibility, and voice handicap index were performed before and after the treatment program according to LSVT principles. Results: Acoustic values such as intensity, frequency, and harmonic to noise ratio increased, and jitter and shimmer parameters decreased. Amount of perception of intelligibility increased. A significant decrease in the scores of the quality of life index related to voice handicap was observed. Conclusion: After treatment by intensive voice therapy, the acoustic assessment revealed improvement in all voice parameters. The perceptual assessment showed improved intelligibility and increased the patient’s quality of life. Intensive voice therapy based on LSVT principles effectively improves the acoustic features, which subsequently cause intelligibility to be more comprehensible. It generally improves verbal communication, which has a positive effect on the patient’s quality of life.