Voice Telerehabilitation in Iatrogenic Unilateral Vocal Fold Paralysis: From Necessity to Opportunity in the COVID-19 Time

Abstract

To evaluate results of telerehabilitation (TR) during the coronavirus disease 2019 pandemic for the treatment of dysphonia caused by permanent post-thyroidectomy unilateral vocal fold paralysis (UVFP). Forty subjects with post-thyroidectomy UVFP (onset <1 month) underwent TR. Videostrobolaryngoscopy, acoustic and perceptual voice analysis and patient self-assessment were carried out in person before, at the end of TR and 6 months later. Twenty-five subjects spontaneously recovered full vocal fold motility at some time during follow-up, whereas 15 had a permanent UVFP at the end of the follow-up period. These subjects constituted our study group. At the early posttherapy control 10/15 subjects (66.6%) showed a complete glottal closure, while in 5/15 (33.3%) a glottal gap remained (P=0.03). These results did not change 6 months after TR. At the late posttherapy control the maximum phonation time improved significantly (P=0.02). Both post-therapy Voice Handicap Index scores were significantly lower than the pre-therapy ones (P=0.04). Grade, Breathiness, and Asthenia parameters of the Grade-Roughness-Breathiness-Asthenia-Strain scale improved 6 months after TR (P < 0.05). The number of voice signals suitable for acoustic analysis increased significantly after therapy. Finally, 87% of patients were satisfied with TR. With careful patient selection, TR may be considered as a promising method for voice therapy in postthyroidectomy UVFP.