Efficacy of Voice Therapy in Rehabilitation of Muscle Tension Dysphonia in Patients of Nonlaryngeal Head and Neck Cancer: A Sequelae of Chemoradiotherapy.

Abstract

The association of voice disorders in laryngeal cancers has been studied extensively; however Dysphonia associated with chemo-radiation in non laryngeal Head and Neck cancer (HNC) is a new area of practice in voice clinics. This study thus aimed to evaluate the efficacy of voice rehabilitation among non-laryngeal HNC survivors who were treated with curative RadioTherapy (RT)/Chemoradiotherapy (CRT) in adjunct with or without surgery. This tertiary institutional assessor blinded quasi experimental study after inclusion and exclusion criteria consisted of a study cohort of 128 patients who within 1-3months of completion of treatment for HNC reported to the laryngology clinic for voice complaints and throat discomfort. All patients underwent documentation of laryngeal endoscopic imaging, acoustics assessment, Aronson's Laryngeal Palpatory Method (LPM) and Voice Handicap Index (VHI). Thereafter they were subjected to Vocal Rehabilitation Therapy (VRT) which constituted of Manual circumlaryngeal therapy, SOVTE, and vocal hygiene program. Re-evaluation of the vocal parameters was done at 6weeks and 3months from the start of the VRT. All parameters were significantly altered at 6weeks and 3months follow-up. Post VRT the videolaryngoscopic findings showed reduction in abnormal supraglottic MTPs with subsequent good approximation of true cords and reduction of involvement of supralaryngeal activities. The Dysphonia Severity Index (DSI) impairment levels and VHI scores showed significant improvement from the baseline to both at 6weeks and 3months of VRT (p < 0.001). DSI and VHI scores even showed significant improvement between 6weeks to 3months of therapy. There was highly significant correlation of VRT with/without surgery, with CRT and in non-smokers at 6weeks and 3months of VRT. In non-laryngeal head and neck malignancies, VRT offered as early as within 1-3months of completion of treatment of HNC ameliorates surgical and chemo-radiation induced Muscle Tension Dysphonia.