Received Voice Therapy Research Articles

Patient Perception of Mental Effort in Voice Therapy

ObjectiveOne challenge in voice therapy is that mastering new vocal techniques is inherently cognitively effortful. While effort is critical for learning, it can also lead to frustration and reduced patient engagement. The purpose of this study was to investigate the relationship between patient-perception of voice handicap and mental effort in voice therapy, and to determine if different therapy approaches and stimuli elicit different perceptions of mental effort. MethodsA non-experimental, prospective investigation was conducted with adult patients receiving voice therapy. Prior to therapy initiation, patients completed the Voice Handicap Index-10 (VHI-10) to quantify perceived severity of their voice disorders. To assess mental effort, a Borg mental effort scale and the NASA Task Load Index (NASA-TLX) were administered following each therapy session. Therapy type and treatment stimulus/level of treatment hierarchy was documented for each session. Kruskal-Wallis H-test was used to compare differences in baseline VHI-10 and mental effort among voice disorder diagnoses. Pairwise comparisons, linear random-intercept mixed-effects model, and generalized estimating equation method were used to determine correlation between VHI-10 and mental effort, and therapy type, stimulus, and effort. ResultsTwenty-seven participants (89% female, 60% white) completed the study. There was no significant difference in VHI-10 or baseline perceptions of mental effort between races or among voice disorder diagnoses. There was a significant positive correlation between VHI-10 scores and session 1 mental effort. There was no significant difference in effort ratings among therapy types, but effort was rated as significantly greater for therapy stimuli that involved connected speech practice than other stimuli. Perceived mental effort significantly decreased over time. DiscussionVoice therapy imposes a cognitive load on the patient, and is particularly challenging for individuals with more severely perceived voice disorders. Further, patients think voice treatment approaches that utilize connected speech stimuli are more effortful than those that use simple stimuli, regardless of treatment target (e.g. resonance, flow).

Prevalence of Voice Problems and Associated Risk Factors in Islamic Religious Orators

Islamic leadership is a diverse profession and previous research has highlighted the increased risk of voice problems among Islamic leaders. The prevalence and risk factors for voice problems among Malayalam-speaking Islamic religious orators have not been adequately investigated. This study aimed to assess the prevalence of self-reported voice problems among Islamic religious orators who recite the Adhaan and those who do not and to examine the impact of age and associated risk factors. This study employed a non-experimental research design using survey research. The current findings report a high prevalence of voice problems among Islamic Adhaan reciters and suggest that age-related differences may influence the risk factors associated with voice problems in this population. Only two participants from the older group of Adhaan reciters had received voice therapy, suggesting that the majority of Islamic religious reciters lack knowledge about voice care and voice therapy. A limitation of the study is the lack of otorhinolaryngological examination, particularly laryngoscopy and voice analysis of Islamic religious orators. Further studies can investigate the effect of vocal hygiene training or similar voice management programs on Islamic religious orators' voices.

Vocal Hygiene Habits in College Students With and Without Self-Reported Symptoms of a Voice Problem

PurposeThe purpose of this study was to determine the prevalence of symptoms of a voice problem in college students and to assess if general health factors and vocal hygiene habits serve as risk factors for symptoms of a voice problem in this population. MethodsParticipants (n = 289) from a university in the United States completed an online survey that included demographic and general health questions, the Screen6 questionnaire, and a list of 23 vocal hygiene habits. Four participants were excluded due to receiving voice therapy and the remaining 285 participants were divided into two groups based on the results of the Screen6 questionnaire: those with two or more symptoms of a voice problem daily or weekly (n = 84) and those with fewer symptoms (n = 201). Results29.5% of the college students in this study experienced two or more symptoms weekly or daily. Throat clearing was the most commonly reported symptom. Risk factors included having a postnasal drip, experiencing severe seasonal allergies, and taking medication for depression or anxiety. The following vocal hygiene habits were reported to occur more frequently in those with symptoms of a voice problem: use your voice until it hurts, use extra muscular effort while talking, use extra respiratory effort while talking, use a pitch that you think is too high, and use a pitch that you think is too low. Non-use behaviors, such as water and caffeine consumption, did not vary significantly between groups. ConclusionsPeople with two or more symptoms of a voice problem daily or weekly report using their voice in a way that may contribute to experiencing these symptoms. Vocal hygiene education for this demographic may be more impactful if it is catered to how the voice is used rather than non-use voice care.

The Effect of a Climate Event on Voice-Related Processes in Seniors

Purpose: This project considered the relationship of harmful algal blooms, specifically red tide, to patient reports of respiratory diseases, use of respiratory medications, reflux symptoms, excessive coughing/throat clearing, water consumption, voice handicap scores, clinician judgments of voice quality, and voice therapy outcomes in senior voice patients in coastal Southwest Florida. Method: A retrospective chart review of 131 seniors receiving voice therapy during 2013–2019 was conducted. Patients formed two groups—those evaluated during periods of high versus low red tide. Patient reports, clinician ratings, and therapy outcomes were analyzed with nonparametric statistics to determine differences between patient groups. Results: No relationship was found between the presence of high red tide and reports of airway disorders, use of airway medications, coughing/throat clearing, Reflux Symptom Index scores, or voice therapy success. A significant relationship was found between high red tide months and ratings of voice severity and Voice Handicap Index scores. Conclusions: Harmful algal blooms may have negatively impacted the voices of seniors in this study, as shown by higher clinician voice severity ratings and higher patient perceptions of voice handicap during periods of high red tide. While voice success was still achieved by many of these seniors, speech-language pathologists should be aware of environmental issues and their possible negative impacts on voice.

The effects of surface electrical stimulation plus voice therapy in Parkinson's disease.

This study aimed to assess the effects of surface electrical stimulation plus voice therapy on voice in dysphonic patients with idiopathic Parkinson's disease. Patients were assigned to 3 treatment groups (n = 28 per group) and received daily treatment for 3 weeks on 5 days a week. All three groups received voice therapy (usual care). In addition, two groups received surface electrical stimulation, either motor-level or sensory-level stimulation. A standardised measurement protocol to evaluate therapeutic effects included the Voice Handicap Index and videolaryngostroboscopy. Voice Handicap Index and videolaryngostroboscopic assessment showed statistically significant differences between baseline and post-treatment across all groups, without any post-treatment differences between the three groups. Intensive voice therapy (usual care) improved idiopathic Parkinson's disease patients' self-assessment of voice impairment and the videolaryngostroboscopic outcome score. However, surface electrical stimulation used as an add-on to usual care did not improve idiopathic Parkinson's disease patients' self-assessment of voice impairment or the videolaryngostroboscopic outcome scores any further.

A Randomized Controlled Trial With Female Teachers: Are there Differences Between and Within the Outcomes in Voice Therapy Groups With and Without Carryover Strategies?

We investigated if outcomes differ between voice therapy groups systematically using carryover strategies (attempts to generalize new vocal skills outside the clinic) and voice therapy with no emphasis on any generalizing process (here referred to as traditional voice therapy). A randomized controlled trial was conducted. Participants (53 female teachers with voice disorders) were randomly allocated into three groups: Carryover (a group receiving voice therapy using carryover strategies), Trad (a group receiving voice therapy with no emphasis on any generalizing process), Controls (a group on an eight-week non-therapy period). Prior to the trial a direct laryngoscopy was performed with a videolaryngostroboscopy system and/or nasofaryngofiberoscope with stroboscopy. Before and after therapy and at follow-up a voice evaluation protocol was implemented consisting of subjective assessments (Questionnaire on Voice Symptoms, and the Voice Activity and Participation Profile; VAPP), and objective measurements (voice sample recordings, acoustic analysis [SPL, sound pressure level; f0, fundamental frequency; alpha-ratio, tilt of the sound spectrum slope]). No differences were found between the groups. Several significant changes occurred within the groups between initial phase vs. post-therapy and initial phase vs. follow-up. In the Carryover group text reading the alpha-ratio became lower (P=0.011) and spontaneous speech f0 increased (P=0.024) after the therapy and [a:] SPL increased (P=0.042) at follow-up. In the Trad group post-therapy [a:] alpha-ratio became lower (P=0.012) and spontaneous speech f0 decreased (P=0.034). After therapy VAPP scores showed improvement in voice-related quality of life in both therapy groups (Carryover P=0.003; Trad P = 0.01) but only in Carryover at follow-up (P=0.000). Voice symptoms decreased in the Carryover group post-therapy (P=0.001) and at follow-up (P=0.000) and after Controls' eight-week non-therapy period (P=0.003). The results showed that carryover strategies give no additional advantages in voice therapy. However, the decreasing trend in the Carryover group's voice complaints at follow-up would suggest that carryover strategies may have long-lasting effects. The results also confirm that voice therapy is efficient in improving voice-related quality of life.

Changes in the Daily Phonotrauma Index Following the Use of Voice Therapy as the Sole Treatment for Phonotraumatic Vocal Hyperfunction in Females.

Purpose The aim of this study was to use the Daily Phonotrauma Index (DPI) to quantify group-based changes in the daily voice use of patients with phonotraumatic vocal hyperfunction (PVH) after receiving voice therapy as the sole treatment. This is part of an ongoing effort to validate an updated theoretical framework for PVH. Method A custom-designed ambulatory voice monitor was used to collect 1 week of pre- and posttreatment data from 52 female patients with PVH. Normative weeklong data were also obtained from 52 matched controls. Each week was represented by the DPI, which is a combination of neck-surface acceleration magnitude skewness and the standard deviation of the difference between the first and second harmonic magnitudes. Results Compared to pretreatment, the DPI statistically decreased towards normal in the patient group after treatment (Cohen's d = -0.25). The posttreatment patient group's DPI was still significantly higher than the control group (d = 0.68). Conclusions The DPI showed the pattern of improved ambulatory voice use in a group of patients with PVH following voice therapy that was predicted by the updated theoretical framework. Per the prediction, voice therapy was associated with a decreased potential for phonotrauma in daily voice use, but the posttreatment patient group data were still significantly different from the normative control group data. This posttreatment difference is interpreted as reflecting the impact on voice use of the persistence of phonotrauma-induced structural changes to the vocal folds. Further validation of the DPI is needed to better understand its potential clinical use.

Effects of Voice Therapy in Early Onset Unilateral Vocal Fold Paralysis in Our Tertiaty Care Centre.

Unilateral vocal cord paralysis presents with dysphonia, shortness of breath and swallowing difficulty and occurs secondary to damage to the recurrent laryngeal nerve by causes such as viral infection, iatrogenic, trauma and idiopathic. The objective of this study was to study the efficacy of early voice therapy in the management of patients with unilateral vocal fold paralysis. Total 116 patients in previous two years were included in this retrospective study suffering from unilateral vocal fold paralysis. They were subjected to a protocol of voice evaluation including Voice handicap index, Maximum phonation time and S/Z ratio. Patients were also examined using Hopkins Examination. All patients included received voice therapy for 6-month duration in 24 sessions. Patients who had started voice therapy early during their symptoms within few days or 1 to 2weeks had better outcomes regarding Voice handicap index, Maximum phonation time and S/Z ratio than patients who had started voice therapy at 1 to 1.5month after symptom onset. Early onset voice therapy may enhance the reduction in glottal gap and improvement of voice quality by hindering the development of faulty hyper functional compensatory behaviors; early voice therapy may therefore enhance the patient's quality of life.

Multi-dimensional investigation of the clinical effectiveness and prognostic factors of voice therapy for benign voice disorders

Voice therapy is frequently recommended as the first-line treatment for benign voice disorders. This study investigated the clinical effectiveness of voice therapy and the prognostic factors of treatment outcomes. We recruited 103 consecutive patients with voice disorders, namely vocal nodules, polyps, and muscle tension dysphonia (MTD), from September 2014 to July 2016. All the patients received voice therapy as the primary treatment. Treatment outcomes were evaluated using auditory perceptual evaluation, acoustic analysis, maximum phonation time, and 10-item voice handicap index (VHI-10). Clinical effectiveness of voice therapy was defined by either 1) a posttreatment VHI-10 score ≤ 10 points or 2) decline of VHI-10 ≥ 4 points. After voice therapy, VHI-10 and perceptual rating of voice quality improved significantly (p<0.05) in the three disease categories. In patients with nodules, all the outcome parameters improved significantly (p<0.05). Patients with good adherence to voice therapy (attending more than four sessions) had a significantly higher effectiveness than those with poor adherence (87% vs. 64%, p<0.05). Patients with high occupational vocal demand also demonstrated a better effectiveness than those with routine vocal demand (90% vs. 70%, p<0.05). Subsequent multivariate analyses revealed that adherence and vocal demand were independently and significantly correlated with clinical effectiveness (p=0.03). Voice therapy is effective for patients with vocal nodules, polyps, and MTD. Adherence to voice therapy and occupational vocal demand are significant prognostic factors for treatment outcomes.

The Effect of the Mother's Participation in Therapy on Children with Vocal Fold Nodules.

Vocal fold nodules (VFN) are a bilateral epithelial thickening of the membranous vocal folds. In this study, children with VFN and their mothers took part in voice therapy. We then compared acoustic analyzes and subjective evaluations to those in previous literature to determine whether voice therapy is more effective for children with VFN when their mothers also take part in therapy. Children aged eight to 12 years who were diagnosed with bilateral VFN between January 2018 and January 2020 were included in this study. Participating children diagnosed with bilateral VFN were divided into two groups based on the wishes and cooperation of their families. Group 1 consisted of 16 patients; Group 2 included 17 patients. The children in Group 1 received voice therapy alone; children in Group 2 took part in therapy with their mothers. For all participants, the average fundemental frequency (F0), jitter percentages, shimmer percentages, maximum phonation time (MPT) and s/z ratios were measured. Pediatric voice handicap index (p-VHI) values were calculated as well. The two groups' measures pre-treatment and post-treatment were compared. Except for p-VHI, no significant difference was observed between the two groups. However, p-VHI post-treatment was significantly lower in Group 2 than in Group 1. Involving the families and even teachers of children with VFN in voice therapy can increase the effectiveness of therapy. The family's involvement increases the child's motivation in therapy. The mother's presence during therapy, supporting the child or even doing the work with the child, can be a very important source of motivation for the child, who may already be tired from school and other activities. Thus, the mother's involvement increases the child's compliance with and interest in therapy.

Barriers to Voice Therapy in Dysphonic Children

The most common etiologies of dysphonia in the pediatric population are vocal fold nodules and muscle tension dysphonia. Vocal therapy is the first line treatment for these disorders in children. Despite this, not all children undergo therapy. The goal of this study is to examine how factors such as patient demographics and parental perceptions differ between children that choose to undergo or not to undergo voice therapy. A retrospective review was conducted of all pediatric patients seen at a tertiary voice clinic between January 2014 and December 2017. Patients were included if diagnosed with vocal fold nodules and/or muscle tension dysphonia. Patients were divided into groups of children that received voice therapy at our institution and those that did not. Data include demographics, Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) scores and pediatric Voice Handicap Index (pVHI) scores. Distance to therapy site was approximated using patient zip codes. Three hundred and forty-six children were included, 224 (65%) boys and 122 (35%) girls. In the 2 years following initial diagnosis, 74 (21%) children participated in voice therapy at our institution. Patients who underwent voice therapy were older than those who did not (mean age: 9.1 [SD 3.5] vs 7.6 [SD 3.8] years; P=0.004). Patients who received voice therapy were more likely to live closer to the therapy site (mean distance: 15.5 [SD 13.0] vs 24.3 [SD 23.9] miles; P< 0.001). Likelihood of receiving voice therapy did not differ by gender or health insurance status (private vs public). Patients who underwent voice therapy had significantly greater CAPE-V Overall Severity scores than those who did not (mean score: 44.6 [SD 19.4] vs 37.4 [SD 18.0]; P = 0.003). Higher CAPE-V Strain scores were associated with increased likelihood of voice therapy. pVHI scores did not differ between the two groups. Older age, shorter distance to therapy site, and increased CAPE-V Overall Severity and Strain scores were associated with higher likelihood of receiving voice therapy. Gender, insurance status, and pVHI scores did not affect likelihood of receiving voice therapy. Patients may primarily consider ease of access and necessity of treatment when considering voice therapy.

Maximum and Minimum Phonatory Glottal Area before and after Treatment for Vocal Nodules.

Background: Vocal fold nodules (VFNs) are a challenge for otolaryngologists. Glottal area (GA) waveform analysis is an examination method used for assessing vocal fold vibration and function. However, GA in patients with VFNs has rarely been studied. This study investigated the maximum and minimum GA in VFN patients using modern waveform analysis combining ImageJ software and videostroboscopy. Methods: This study enrolled 42 patients newly diagnosed with VFN, 15 of whom received voice therapy and 27 of whom underwent surgery. Acoustic parameters and maximum phonation time (MPT) were recorded, and patients completed the Chinese Voice Handicap Index-10 (VHI-C10) before and after treatment. After videostroboscopy examination, the maximum and minimum GAs were calculated using ImageJ software. The GAs of patients with VFNs before and after surgery or voice therapy were analyzed. Results: The MPTs of the patients before and after voice therapy or surgery did not change significantly. VHI-C10 scores decreased after voice therapy but the decrease was nonsignificant (14.0 ± 8.44 vs. 9.40 ± 10.24, p = 0.222); VHI-C10 scores were significantly decreased after surgery (22.53 ± 7.17 vs. 12.75 ± 9.84, p = 0.038). Voice therapy significantly increased the maximum GA (5.58 ± 2.41 vs. 8.65 ± 3.17, p = 0.012) and nonsignificantly decreased the minimum GA (0.60 ± 0.73 vs. 0.21 ± 0.46, p = 0.098). Surgery nonsignificantly increased the maximum GA (6.34 ± 3.82 vs. 8.73 ± 5.57, p = 0.118) and significantly decreased the minimum GA (0.30 ± 0.59 vs. 0.00 ± 0.00, p = 0.036). Conclusion: This study investigated the GA of patients with VFNs who received voice therapy or surgery. The findings indicated that voice therapy significantly increased maximum GA and surgery significantly decreased minimum GA. GA analysis could be applied to evaluate the efficacy of voice therapy, and it may help physicians to develop precise treatment for VFN patients (either by optimizing voice therapy or by performing surgery directly).

Treatment Efficacy of Voice Therapy Following Injection Laryngoplasty for Unilateral Vocal Fold Paralysis

Injection laryngoplasty (IL) is performed to reduce the gap between vocal folds induced by unilateral vocal fold paralysis (UVFP). Voice quality after IL may be different due to other factors that influence voice quality. Voice therapy has been reported to improve voice quality after IL in patients with UVFP. This study evaluated the efficacy of voice therapy combined with IL. Patients with UVFP who underwent IL as primary therapy from March 2017 to June 2019 were evaluated. The enrolled patients were divided into two groups, those who did and did not receive voice therapy after IL. Voice quality was evaluated using perceptual, acoustic, and aerodynamic parameters, and voice handicap index-30 scores one month after IL and after completing each treatment. Of 261 patients who underwent IL during the study period, 40 were enrolled, including 21 who did and 19 who did not receive voice therapy. Voice parameters one month after IL did not differ between these two groups. Jitter, shimmer, noise-to-harmonic ratio, and mean flow rate decreased, while maximum phonation time increased after voice therapy (both P < 0.05). In the absence of voice therapy, improved voice parameters were maintained for six months after IL. Total voice handicap index-30 scores decreased, from 35.6 to 19.1 (P < 0.05), in patients who received voice therapy. Voice therapy following IL is beneficial to patients with UVFP. Combined treatment can help to maintain improved voice quality more than six months after IL.

Is there an improvement on acoustic voice parameters in patients with bilateral vocal fold nodules after voice therapy? a meta-analysis.

The aim of this study is to estimate the effect of voice therapy intervention in adults with vocal fold nodules, on three acoustic voice parameters (fundamental frequency, jitter and shimmer). The purpose of this meta-analysis is to present evidence based on literature regarding objective acoustic voice parameters changes, after voice therapy, in patients with bilateral VFNs. A pooled statistical analysis comparing pre- and post-therapy measurements of three acoustic voice parameters (average F0, % jitter and % shimmer) were performed. A literature review was performed by searching studies in adults, with bilateral vocal fold nodules who received voice therapy, and where voice quality was evaluated quantitatively using acoustic analysis, before and after treatment. Meta-analysis was performed using random-effects model. PubMed, CINAHL, CENTRAL and Web of Science were searched for retrospective and prospective cohort, cross-sectional and case-control with comparative studies in adults published between January/1995 and March/2019 and English written. Search terms used were: intervention, therapy, vocal, voice, nodules, bilateral, multidimensional assessment, acoustic and analysis. Overall 1950 articles were identified. After removing repeated articles and conducting screening stages using inclusion and exclusion criteria, a total of four studies were selected with 147 participants for the meta-analysis. The pooled results analysis showed a statistically significant effect in two acoustic parameters after voice therapy: (1) F0 [increased mean difference post-therapy was 33.00Hz (95% CI 20.26-45.74, p < 0.001)] and (2) jitter (%) [decreased mean difference post-therapy was 0.59% (95% CI 0.23-0.94%, p = 0.001)]. In addition, a non-statistically significant effect in shimmer (%) [decreased mean difference post-therapy was 2.98% (95% CI -0.03-6.00, p = 0.052)]. Acoustic analysis has a clinical role in patients with vocal fold nodules, by objectively assessing and providing data on the effect of voice therapy in voice acoustic parameters. This meta-analysis has shown that patients with vocal fold nodules improved their acoustic voice parameters after receiving voice therapy.

Modificación del índice de perturbación vocal integrado mediante terapia de voz en personas con disfonía funcional en Santiago de Cali, Colombia

IntroductionVoice therapy is a practice that is not extensively based on research evidence; the assessment and monitoring of rehabilitation programmes are generally based on perceptual analysis, and few acoustic measures have not been correlated with each other to determine the extent of vocal risk among different kinds of populations with dysphonia.The aim of this research was the acoustic assessment of the effect of 2types of voice therapy (mixed and direct) in individuals with functional dysphonia using the integrated vocal disturbance index. MethodA sample of 20 functional dysphonic individuals aged between 20 and 60 years was selected. The individuals were assessed through an acoustic analysis using Anagraf software. The sample was split into 2groups; the first one received mixed voice therapy and the second only received direct voice therapy. The post-therapy voices were acoustically assessed, comparing the effect of the techniques proposed. ResultsThe integrated vocal disturbance index was found to be altered for most of the individuals in both groups before receiving voice therapy. On completion of the mixed and direct voice therapy, it was found that the index classified the voices into normal and at risk, decreasing their extent of disturbance. ConclusionThe integrated vocal disturbance index was favourably modified for both therapy groups. However, this was statistically more significant for the group that received mixed voice therapy.

Characteristics of Functional Dysphonia in Children

Functional dysphonia refers to a voice disorder without organic laryngeal disease. In this article, the clinical features and therapeutic strategies of functional dysphonia in children were investigated. Retrospective analysis of 595 cases of children with dysphonia 3-18 years of age, including 42 patients diagnosed with functional dysphonia. The patients were distributed by age into four groups:3-6, 7-10, 11-14, 15-18 years. The clinical features, laryngeal signs, voice characteristics, pediatric voice handicap index, and therapeutic effects were analyzed. In this study, 7.1% of the patients were struck with functional dysphonia. 7 (16.7%) patients aged 7-10 years, 16 (38.1%) aged 11-14 years, and 19 (45.3%) patients aged 15-18 years, and there were 23 males and 19 females. Thirteen (31.0%) patients had no cause identified, while some were triggered by upper respiratory tract infection (16 cases, 38.1%), voice overuse (9 cases, 21.4%), or other factors (4 cases, 9.5%). Thirty-four (80.9%) patients had prominent hoarseness, with aphonia in 25 (73.5%) patients, and other 7 (16.7%) patients (15-18 years) showed vocal breaks or vocal effort (4 patients), and high pitch or pitch instability (3 patients). Some patients were accompanied by reduced mucosal waves, supraglottic compensations, and glottal insufficiency. Twelve patients received voice therapy, and their voice was improved after treatment. In our study, functional dysphonia characterized 7.1% of the patients with voice disorders in children. All patients were 7-18 years of age, particularly 11-18 years. The main triggers of the disorder were upper respiratory tract infection, unknown and voice overuse. Other than apparent hoarseness, some 15-18 years patients experienced vocal breaks, vocal effort, or abnormal pitch. Supraglottic compensations and glottal insufficiency were observed in more than half of the patients. Symptomatic voice therapy obtained significant effects.

Patients’ Perceptions of and Attitudes Toward Voice Therapy: A Pilot Study

Patient perceptions of the therapeutic process have been shown to influence outcomes in various healthcare fields. However, the voice therapy literature lacks a thorough examination of patients' perceptions of the voice therapy process. This cross-sectional pilot study analyzed patient perceptions of voice therapy across four different areas: patient understanding of therapy, the home therapy program, perception of improvement of symptoms, and prioritization of therapy. The study included patients receiving voice therapy for various disorders (n = 49). Results showed significant differences by patient age and the number of therapy sessions completed. Patients indicate increased understanding (P = 0.0676) and appeared to notice more improvement as therapy progressed (P = 0.010). Younger patients indicate higher adherence to their home program (P < 0.001, P = 0.003). Additionally, correlations were found between patient understanding and the extent to which they prioritize therapy (r = 0.53, P < 0.001) and the extent to which patients notice improvement (r = 0.51, P < 0.001). This study highlights possible age and gender differences and the ways in which perceptions may change over time and affect outcomes.

Effects of Voice Therapy on Laryngeal Motor Units During Phonation in Chronic Superior Laryngeal Nerve Paresis Dysphonia

Injury to the superior laryngeal nerve can result in dysphonia, and in particular, loss of vocal range. It can be an especially difficult problem to address with either voice therapy or surgical intervention. Some clinicians and scientists suggest that combining vocal exercises with adjunctive neuromuscular electrical stimulation may enhance the positive effects of voice therapy for superior laryngeal nerve paresis (SLNP). However, the effects of voice therapy without neuromuscular electrical stimulation are unknown. The purpose of this retrospective study was to demonstrate the clinical effectiveness of voice therapy for rehabilitating chronic SLNP dysphonia in two subjects, using interspike interval (ISI) variability of laryngeal motor units by laryngeal electromyography (LEMG). Both patients underwent LEMG and were diagnosed with having 70% recruitment of the cricothyroid muscle, and 70% recruitment of the cricothyroid and thyroarytenoid muscles, respectively. Both patients received voice therapy for 3 months. Grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, stroboscopic examination, aerodynamic assessment, acoustic analysis, and Voice Handicap Index-10 were performed before and after voice therapy. Mean ISI variability during steady phonation was also assessed. After voice therapy, both patients showed improvement in vocal assessments by acoustic, aerodynamic, GRBAS, and Voice Handicap Index-10 analysis. LEMG indicated shortened ISIs in both cases. This study suggests that voice therapy for chronic SLNP dysphonia can be useful for improving SLNP and voice quality.

Efficacy of Voice Therapy for Patients With Early Unilateral Adductor Vocal Fold Paralysis

Although a variety of therapeutic techniques have been suggested for patients with unilateral adductor vocal fold paralysis (UAVFP), they were not aimed specifically at determining the efficacy of early intervention for these patients. The purposes of this study are to explore a protocol of voice therapy and to investigate its efficacy in voice therapy for patients with early UAVFP. A 12-week planned voice therapy protocol, including vocal function exercise, hard attack, and resonance voice therapy, was given to 10 patients within 6 months of initial diagnosis. Additionally, nine patients diagnosed with UAVFP within 6 months served as controls. Multidimensional evaluations of voice function were obtained for statistical analyses. Compared to a control group, the experimental group receiving voice therapy exhibited significant improvement in the following: (1) glottal closure; (2) voice quality of grade, breathiness, monotone, and resonance; (3) acoustic measurements of jitter, shimmer, and noise-to-harmonic ratio; (4) aerodynamics measurements of maximum phonation time, phonation threshold pressure, and phonation quotient; and (5) Voice Handicap Index of functional subscale. This prospective study established an effective protocol of early intervention of voice therapy in patients with UAVFP and demonstrated its efficacy in data on laryngeal physiology, voice quality, voice stability, voice efficiency, and communication function.

Voice Quality Following Unilateral Vocal Fold Paralysis: A Randomized Comparison of Therapeutic Modalities

In this work, a study on the efficacy of different therapeutic modalities in patients with unilateral vocal fold paralysis (UVFP) was carried out. The study included 20 patients with UVFP, divided into two groups. The objective of this work is to evaluate the voice quality in these patients and to compare the voice following surgery and voice therapy. Group I received voice therapy and group II underwent thyroplasty type I and type IV. The voice was assessed pretreatment and 1 and 3 months posttreatment. Different parameters, such as habitual fundamental frequency (F0), signal-to-noise ratio, jitter, shimmer, maximum phonation duration, s/z ratio, and objective and subjective ratings of dysphonia, were analyzed. It was observed that in group I, all the parameters in seven out of ten patients improved significantly, except for shimmer. In group II, voice quality improved in 70% of the patients with all the parameters. As per previous studies, jitter and shimmer improved after a rehabilitation procedure. However, in this work, it is observed that shimmer did not improve in patients receiving voice therapy. The present study is the first of its type documenting and comparing the efficacy of voice therapy and thyroplasty type I and type IV in patients with UVFP.