Respiratory Lung Volume Training improves speech breathing and voice in primary muscle tension dysphonia

Comparative Investigation of Laryngeal Palpation Scale Between Primary and Secondary Muscle Tension Dysphonia

A Conceptual Framework and Treatment Taxonomy for Respiratory Lung Volume Training (RLVT)

The purpose of this randomized controlled trial was to determine the short- and long-term effects of Respiratory Lung Volume Training (RLVT) on speech breathing and voice in people with primary muscle tension dysphonia (pMTD). Twenty-four participants with pMTD were randomized to either RLVT or control training (ConT) and completed six 1-hr training sessions. Increased lung volume initiations and terminations were targeted in RLVT using real-time visual biofeedback of lung volumes, whereas the ConT condition implemented a sham Expiratory Muscle Strength Trainer (placebo). Respiratory inductive plethysmography was used to measure speaking lung volumes before and after training. Voice and vocal function outcomes included acoustic measures, auditory-perceptual listener ratings, and self-ratings of speaking effort and impact of the voice disorder. Long-term follow-up assessments were completed for the RLVT condition. Increases in lung volume initiation, termination, excursion, and amount of lung volume used per syllable were all significantly greater after RLVT than after ConT. All increases in respiratory outcome measures were maintained at 3 and 6 months posttraining except for lung volume excursion, which was significantly higher than baseline levels at 6 months but not 3 months posttraining. Acoustic and auditory-perceptual voice severity also showed significantly greater improvement after RLVT than after ConT with gains maintained for both follow-ups. Relative to vocal function, whereas speaking effort was significantly lower after RLVT than after ConT, both conditions produced similar and significant reductions in self-rated voice handicap. Improvements in these vocal function measures were maintained at long-term follow-up timepoints. Speech breathing, voice, and speaking effort outcomes showed significantly greater improvement after RLVT than after ConT in this group of participants with pMTD, with improvement maintained at 6 months post-RLVT. The higher levels of lung volume targeted in RLVT may promote more efficient vocal behavior through functional and mechanical respiratory-laryngeal interactions while decreasing speaking effort.

Isolated and Combined Respiratory Training for Muscle Tension Dysphonia: Preliminary Findings

Preliminary Effects of Respiratory Lung Volume Training (RLVT) on Hyolaryngeal Kinematics in People With Primary Muscle Tension Dysphonia.

Risk of Fibromyalgia in Patients with Primary Muscle Tension Dysphonia: A Prospective Pilot Study

To investigate the risk of fibromyalgia in patients with primary muscle tension dysphonia. A retrospective review was conducted of patients with primary muscle tension dysphonia, diagnosed based on history of dysphonia with evidence of laryngeal muscle tension on examination. Fibromyalgia was assessed using the Fibromyalgia Rapid Screening Tool ('FiRST'). Fifty patients were enrolled: 25 with primary muscle tension dysphonia (study group) and 25 matched controls. The mean age of the study group was 50.7 ± 15.2 years versus 49.5 ± 18.6 years for the controls, with a male to female ratio of 3:2 for both groups. Fifty-six per cent tested positive for fibromyalgia in the study group versus 4 per cent in the controls (p < 0.001). The mean Voice Handicap Index 10 score in the study group was significantly higher for those who screened positive for fibromyalgia compared to those who screened negative. There was a positive, strong point-biserial correlation between Fibromyalgia Rapid Screening Tool and Voice Handicap Index 10 scores (r = 0.39; p = 0.09). These results suggest that fibromyalgia is a significant co-morbid condition in primary muscle tension dysphonia.

To explore the risk of obstructive sleep apnea (OSA) in patients with primary muscle tension dysphonia (MTD). The medical records of patients diagnosed with primary MTD between November 2021 and March 2023, were reviewed. The risk of having OSA was assessed by looking at the scores of two validated questionnaires, namely the STOP-BANG questionnaire and the Berlin questionnaire. A total of 40 patients with primary MTD were enrolled in this study, including 16 females (40%) and 24 males (60%). The mean total STOP-BANG score was 3.57 ± 1.67. Seventeen of the study group had intermediate risk of OSA, and 14 had high risk, accounting for 77.5% of patients with primary MTD. When using the Berlin questionnaire, the mean total score was 1.65 ± 0.95, and 67.5% of the study group had a score > 2 and were at high risk of having OSA. The results of this study indicate that patients with primary MTD are at moderate to severe risk of having OSA.

Introduction: The link between nasal obstruction and muscle tension dysphonia (MTD) has not been previously investigated despite the well-established relationship between respiratory and voice disorders. The aim of this study was to examine the prevalence of nasal obstruction and sinonasal symptoms in patients with primary MTD. Methods: Patients presenting to the Voice Unit at a tertiary referral center between July 2022 and October 2023 and diagnosed with primary MTD were recruited. The severity of nasal obstruction was assessed using the Visual Analogue Scale (VAS), and sinonasal symptoms were assessed using the Sinonasal Outcome Test-22 (SNOT-22) questionnaire. A control group matched by age and gender, with no dysphonia and normal laryngeal examination was recruited. Results: 65 patients, 31 with MTD and 34 controls, were enrolled. Nineteen patients of the study group (61.3%) had a VAS >4, i.e., moderate to severe nasal obstruction compared to only five in the control group (14.7%) (p < 0.001). Using the SNOT-22, 61.3% of patients with MTD had moderate to severe sinonasal symptoms as compared to only 5.9% of the control group (p < 0.001). Conclusions: Patients with primary MTD are more likely to have nasal obstruction/sinonasal symptoms in comparison to patients with no dysphonia and normal laryngeal examination.

The Effectiveness of Eclectic Voice Therapy on Multidimensional Voice Parameters in Patients with Primary Muscle Tension Dysphonia.

Validity and Reliability of Surface Electromyography in the Assessment of Primary Muscle Tension Dysphonia

Do Phonatory Aerodynamic and Acoustic Measures in Connected Speech Differ Between Vocally Healthy Adults and Patients Diagnosed with Muscle Tension Dysphonia?

Strain Elastosonography Measurement in Patients with Primary Muscle Tension Dysphonia Compared with Healthy Speakers: A Pilot Study

To determine whether radiographic measures of hyoid position, laryngeal position, and hyolaryngeal space during phonation were different for people with primary muscle tension dysphonia (MTD) as compared to control participants without voice disorders. Prospective, quasi-experimental research design. Twenty participants, 10 with primary MTD and 10 without voice disorders who were age and sex matched were studied radiographically while producing phonation. Lateral x-ray images were obtained for each participant during three tasks: resting state, sustained phonation, and a swallow-hold maneuver. Vertical positions of the hyoid and larynx were measured on a Cartesian coordinate system and were normalized to reflect change from rest during phonation. Normalized, vertical hyoid, and laryngeal positions during phonation were significantly higher for people with MTD than for control participants. Normalized hyolaryngeal space during phonation did not show differences between groups. A low to moderate significant correlation for radiographically measured hyoid and laryngeal position and the total score from a subjective laryngeal palpatory scale were evidenced, but no relationship was evidenced for radiographic laryngeal position and the laryngeal position subscore of the palpatory examination. Objective determinants of physiology are critical for the differential diagnosis of MTD and its effective treatment. Radiographic findings from this study indicate that hyoid and laryngeal positions during phonation are higher in people with primary MTD as compared to people without voice disorders.

The Effect of Adding Cricothyroid Visor Maneuver to Voice Facilitating Techniques on Improving Voice in Individuals With Primary Muscle Tension Dysphonia: A Pilot Randomized Clinical Trial