Vocal Function Exercises for Muscle Tension Dysphonia: Auditory-Perceptual Evaluation and Self-Assessment Rating

Is Surface Electromyography (sEMG) a Useful Tool in Identifying Muscle Tension Dysphonia? An Integrative Review of the Current Evidence

OBJECTIVE

This integrative review aims to determine the quality level of evidence on using surface electromyography (sEMG) as a diagnostic tool in identifying muscle tension dysphonia.

METHOD

Two independent reviewers used one search engine and five databases to identify sEMG studies published between January 1980 and December 2020, using a set of specified search terms related to muscle tension dysphonia. The selected articles were systematically evaluated by two independent raters using a modified critical appraisal of diagnostic evidence (m-CADE) form.

RESULTS

Nine articles that satisfied the inclusion criteria were selected from among 576 studies for evaluation. These nine studies showed varied methodological approaches in sEMG measurements, including electrode configuration and position, tasks used in sEMG data collection, outcome measure, and normalization procedures. Five studies showed relatively high m-CADE scores, which were indicative of "suggestive validity and compelling importance". Two studies were rated as "suggestive validity and importance", while two remaining studies were rated as "less suggestive or equivocal validity and importance".

CONCLUSIONS

The review found a moderate level of evidence that sEMG can be a potentially useful tool with diagnostic value in identifying muscle tension dysphonia. However, evidence is not yet available to determine the diagnostic accuracy of sEMG for muscle tension dysphonia. More studies are needed, and it is recommended that future studies involving sEMG and reference measurements should be undertaken using a blinding procedure in order to control any subjective biases. Details of the population that the sEMG has been tested on should be outlined clearly so that spectrum bias could be eliminated or minimized in the application process. Furthermore, it is suggested that a reliable and valid protocol in collecting sEMG data during speech should be developed to minimize the variability of sEMG measures in assessing muscle activities during speech.

Effects and Differences of Voice Therapy on Spasmodic Dysphonia and Muscle tension dysphonia: A Retrospective Pilot Study

OBJECTIVES

Laryngeal and voice findings of adductor spasmodic dysphonia (AdSD) and muscle tension dysphonia (MTD) are similar, and it is difficult to distinguish between both disorders. The purpose of this study is to ascertain the effect of voice therapy on MTD and AdSD and clarify their difference.

METHODS

A total of 49 patients, including 22 patients with MTD (MTD group) and 27 patients with AdSD (SD group), were included in the study. The MTD scores were evaluated, and aerodynamic analysis (maximum phonation time [MPT], mean airflow rate [MFR], highest pitch, lowest pitch, and pitch range), perceptual evaluation (Strangulation, Interruption, and Tremor), acoustic analysis (PPQ, APQ, NHR, and DVB), and subjective assessment (voice handicap index-10 [VHI-10]) were performed before and after voice therapy.

RESULTS

The MTD score, highest pitch, pitch range, strangulation, PPQ, APQ, NHR, and VHI-10 showed significant improvement after treatment in the MTD groups. On the other hand, the effect of voice treatment on AdSD was poor despite the improvement in the MTD score.

CONCLUSIONS

This study could serve as a basis for conducting prospective studies to verify the effects of voice therapy on MTD and AdSD.

Effect of Clinical Expertise on Efficacy of Vocal Function Exercises in Individuals With Typical Voice

OBJECTIVES/HYPOTHESIS

To determine the effect of clinical expertise on efficacy of Vocal Function Exercises (VFEs) as measured by change in percent of maximum phonation time goal attained. The hypothesis was that clinical expertise would result in greater increases in percent of maximum phonation time goal attained.

STUDY DESIGN

Randomized controlled trial.

METHODS

A convenience sample of 19 individuals with typical voice was recruited in a university academic clinic setting. All participants completed baseline assessment and 17 completed all study procedures. Participants were randomized to receive VFEs from an expert voice clinician with more than 40 years' experience (expert group (EG)) or from a master's student in Communication Sciences and Disorders trained in VFEs (novice group (NG)). The primary outcome measure was change in percent of maximum phonation time goal attained during VFE tasks 1 and 4.

RESULTS

Mean change scores for maximum phonation time were 27.71 (P = 0.001) and 25.31 (P = 0.003) for EG and NG, respectively. Both groups improved significantly on the primary outcome measure, but the difference between groups was not statistically significant (P = 0.759). A Hedges'-g effect size of -0.14 [-1.10, 0.81] was obtained comparing EG and NG groups, indicating a small negative effect of limited clinical expertise on VFE outcomes in individuals with typical voice.

CONCLUSIONS

Speech-language pathologists with varied levels of expertise are capable of efficaciously administering VFEs in individuals with typical voice.

Development and Psychometric Evaluation of the Laryngeal Palpation Pain Scale (LPPS)

INTRODUCTION

One of the most important assessment and therapy methods for patients with muscle tension dysphonia (MTD) and other voice disorders is laryngeal palpation. However, there is no comprehensive scale for measuring pain during laryngeal palpation. The goal of the present study was to develop and validate a new scale to evaluate pain during palpation for patients with MTD.

METHODS

The present study consisted of two phases: (1) Development of the Laryngeal Palpation Pain Scale (LPPS) based on an in-depth literature review, the palpatory evaluation of MTD patients, interviews with experts in the field of voice disorders, and consultation with a registered pain expert, and (2) evaluation of the validity and reliability of the LPPS. The validity of the LPPS was investigated using qualitative and quantitative content validity, qualitative face validity, discriminant validity, and convergent validity. Content validity of the LPPS was assessed by experts' opinions (10 speech-language pathologists and five laryngologists), and face validity was investigated using the opinions of speech-language pathologists. The reliability of the LPPS was determined using test-retest and inter-rater reliability.

RESULTS

The item generation phase of the study led to the development of a scale to assess pain during palpation that included eleven locations in the neck region for palpatory assessment. These 11 items were divided into 13 different items (neck locations) based on the opinions of the experts. The content validity ratio values of all scale items were higher than 0.78. The content validity index (CVI) value for each of the items of the scale was higher than 0.79 and for the entire scale CVI (S-CVI) was 0.915. The results of the reliability of the LPPS items were satisfactory with weighted kappa values ranging from 0.655 to 1 for the test-retest and 0.77-1 for the inter-rater reliability. Convergent validity of the LPPS was shown with a significant positive correlation (r = 0.68) between the LPPS and the pain severity of vocal tract discomfort (P < 0.001). Moreover, MTD patients had more pain severity than the control group in all items of the LPPS (P < 0.05) except for the submental item (P = 0.89). These results indicate that the LPPS can differentiate MTD patients from healthy subjects. The final version of the LPPS includes 13 potential pain locations. The severity of pain at each of these locations is determined on a numeric pain rating scale of zero (no pain) to ten (the most severe pain).

CONCLUSION

The study showed that the LPPS is a valid and reliable scale to assess pain in MTD patients during palpation evaluations. More studies are recommended for further psychometric evaluation of the LPPS including responsiveness to change (the use in before-and-after intervention studies) and concurrent validity of the LPPS. The LPPS can be used for clinical and research purposes.

An eclectic Voice Therapy Program for the Treatment of Hyperfunctional Voice Disorders (HFVD)

PURPOSE

An eclectic voice therapy program includes sequenced and structured set of exercises combining direct and indirect intervention methods. Tailor-made exercise prescription with specific cultural adaptations are needed to provide a holistic change to voice quality.1 This study detailed the construction of an exercise prescription for participants with hyperfunctional voice disorder [HFVD] in the Indian context.

METHOD

The exercise program was developed based on literature related to vocal therapy approaches and delivery methods. Adaptations were introduced to a selected set of exercises. Five voice experts verified the exercises and their prescription for content and feasibility of use in the Indian context. Modification suggested by the experts were included for framing the final version of the exercise program. This structured therapy program was planned for 6 weeks (30 minutes duration/session offered individually twice per week, with a gap of two days between sessions in a week) with the goals to improve voice quality, flexibility, and endurance while speaking. Five participants with HFVD partook in the study for pilot testing. Stroboscopy, perceptual voice analysis, Dysphonia Severity Index (DSI) and Vocal Fatigue Index in Tamil (VFI-T) were used to report the therapy outcomes. Participants' report on the learning process and generalization of the program were documented. Wilcoxon-signed rank test was used to test the pre-post outcome measures.

RESULTS

An eclectic voice therapy program, i.e., Comprehensive Voice Habilitation Program [CVHP] was constructed and it included vocal hygiene instructions, warm-up & cool-down, easy onset, resonant voice, and carry over exercises. Participants completed the program in 14-18 sessions (over 7 to 9 weeks of therapy). All participants showed significant changes in vocal fold movement patterns, reduction in ventricular hyperadduction, overall grade of voice quality, DSI and VFI-T. Participants reported that pictorial illustrations, feedback, and monitoring sheets were useful in learning the exercises.

CONCLUSION

CVHP showed significant change in the voice-related outcome measures and was a viable program for treating HFVD.

The Effect of Maximum Phonation Time Goal on Efficacy of Vocal Function Exercises

OBJECTIVES/ HYPOTHESIS

To determine the effect of maximum phonation time goal on efficacy of Vocal Function Exercises (VFEs) as measured by percent of maximum phonation time goal attained. The hypothesis was that provision of a maximum phonation time goal would result in greater increases in percent of maximum phonation time goal attained.

STUDY DESIGN

Randomized controlled trial.

METHODS

A convenience sample of individuals with normal voice were recruited in a university academic clinic setting. Of 34 participants who volunteered for the study, 28 completed baseline assessment and 19 completed all study procedures. Participants were randomized to complete VFEs with knowledge of their maximum phonation time goal (standard goal, SG), with knowledge of their maximum phonation time goal after three weeks (delayed goal, DG), or without knowledge of their maximum phonation time goal (no goal, NG). The primary outcome measure was percent of maximum phonation time goal obtained during VFE tasks one and four.

RESULTS

Mean change scores for maximum phonation time were 32.50 (SG), 34.55 (DG), and 21.02 (NG). Hedges' g effect sizes of -0.10 (-1.19, 0.99) and 0.56 (-0.55, 1.67) were obtained comparing DG and SG groups, and NG and SG groups, respectively.

CONCLUSIONS

Absence of maximum phonation time goal attenuates VFE efficacy; maximum phonation time goal is an active ingredient within VFEs.

Efficacy of a Semi-Occluded Vocal Tract Exercises-Therapeutic Program in Behavioral Dysphonia: A Randomized and Blinded Clinical Trial

PURPOSE

Semi-occluded vocal tract exercises (SOVTE) may improve the source and filter interaction by changing the acoustic characteristics and the impedance of the vocal tract, both in dysphonic and vocally healthy populations. However, there are a few studies that verify the effects of these exercises in a clinical trial. Thus, this study's purpose was to analyze the effectiveness of the SOVTE-Therapeutic Program (SOVTE-TP) in vocal quality and self-assessment, comparing it with Vocal Function Exercises.

METHOD

Eighteen (eight men; 10 women), ages 18-50, with behavioral dysphonia participated in this randomized and blinded clinical trial. The participants were equally randomized into two groups: Experimental Group and Vocal Function Exercises Group. They were assessed at three moments: before the treatment, after finishing it, and one month after finishing the treatment--follow up. Acoustic measures (ie, fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, cepstral peak-smoothed, alpha ratio, and L1-L0), auditory-perceptual analysis, vocal fatigue index (VFI), self-perceived resonant voice, and vocal handicap index-30 (VHI-30) were measured at all assessment moments. For the two groups, the interventions happened twice per week (four weeks) and lasted 35 minutes. It was applied the repeated-measures ANOVA test (P< 0.05) and Tukey Test.

RESULTS

The acoustic measures and auditory-perceptual had no differences between the groups and moments, respectively, which means that SOVTE-TP did not cause any harm. The auditory-perceptual analysis showed a mild deviation of participants' vocal quality. All groups reduced the VFI and VHI-30 scores in M2 and kept these results at M3 also, the vocal economy sensation increased in M2, decreasing slightly in M3.

CONCLUSION

SOVTE-TP has positive effects regarding self-assessment (VFI, VHI, and resonant voice quality) on patients with mild behavioral dysphonia, and it provides the same effects as VFE.

Vocal Function Exercises With and Without Maximally Sustained Phonation: A Randomized Controlled Trial of Individuals With Normal Voice

OBJECTIVES

To determine the effect of maximally sustained phonation on efficacy of Vocal Function Exercises as measured by percent of maximum phonation time goal attained. The hypothesis was that maximally sustained phonation would result in greater improvements in percent of maximum phonation time goal attained.

STUDY DESIGN

Randomized controlled trial.

METHODS

A convenience sample of individuals with normal voice were recruited in a university academic clinic setting. Of 34 participants who volunteered for the study, 31 completed baseline assessment and 23 completed all study procedures. Participants were randomized to complete Vocal Function Exercises (traditional group TG), modified Vocal Function Exercises with reduced requirement for maximally sustained phonation (midpoint group MG), or modified Vocal Function Exercises with removed requirement for maximally sustained phonation (baseline group BG). The primary outcome measure was percent of maximum phonation time goal obtained during Vocal Function Exercises.

RESULTS

The MG (p = 0.008) and TG (p = 0.001) groups significantly improved percent of maximum phonation time goal attained after six weeks of exercise, while the BG group (p = 0.0202) did not (ɑ = 0.0125). Difference among groups was not statistically significant (p = 0.67, ɑ = 0.0125). Hedges' g effect sizes of 0.29 (-0.66, 1.25) and 0.51 (-0.57, 1.58) were obtained comparing MG and TG groups, and BG and TG groups, respectively.

CONCLUSIONS

Greater requirements for maximally sustained phonation improved efficacy of Vocal Function Exercises in enhancing normal voice as measured by percent of maximum phonation time goal attained. Maximally sustained phonation may be modified to some extent while preserving efficacy of Vocal Function Exercises, however complete elimination of maximally sustained phonation may attenuate improvement. Additional research in a clinical population is warranted.

Immediate Effects of Combining Kinesio Tape with Voice Therapy in Patients with Muscle Tension Dysphonia

INTRODUCTION

The present study investigated the immediate effect of adding Kinesio taping along with voice therapy for the treatment of muscle tension dysphonia patients.

MATERIALS AND METHODS

Twenty patients with primary muscle tension dysphonia (MTD) (12 males and 8 females) with a mean age of 36.95 ± 9.58 years participated in the study. Participants were assigned to two groups: one group (6 males and 4 females) received only traditional voice therapy (VT) and the other group (6 males and 4 females) received Kinesio taping (KT) and voice therapy (VT). The VT group received laryngeal manual therapy (LMT) (for 15 minutes) and voice therapy techniques including humming, chewing, and yawn-sigh (for 15 minutes). The VT + KT group received both KT and the same VT as the first group. KT was applied to the sternocleidomastoid, infralaryngeal, and supralaryngeal muscles of the neck. Auditory-perceptual assessments using CAPE-V, acoustic voice analysis, and assessments of vocal tract discomfort and pain were used to evaluate the effects of a single treatment session. The Wilcoxon and Mann-Whitney U tests were used for data analysis.

RESULTS

The results of within-group comparison of the auditory-perceptual assessment (overall severity, roughness, breathiness, and strain) in both sustained vowels and connected speech tasks showed a significant reduction in all mentioned items in both groups (P < 0.05). Acoustic voice analysis showed significant improvement of HNR in the KT + VT group for both sustained vowels and connected speech tasks, and significant improvement of jitter in the VT group for sustained vowels (P < 0.05). Regarding vocal tract discomfort, the symptom of tightness in the KT + VT group, irritability and pain in the VT group, and the overall score of vocal tract discomfort in both groups, significantly decreased (P < 0.05). A significant decrease in pain severity in the front of the neck, throat, and larynx was reported by MTD patients in both groups (P < 0.05). Between-group comparisons indicated a significant difference only in the pain item of the VTD scale (P < 0.05) with greater pain decrease for the VT group. Comparison of the mean of differences showed that the VT group reduced irritability more than the KT + VT group (P < 0.05).

CONCLUSION

The present study showed that voice therapy with and without Kinesio taping can improve patients' voice quality (auditory-perceptual and acoustic voice analysis) and reduce vocal tract discomfort and pain in MTD patients after one therapy session. Moreover, MTD patients treated with KT + VT did not experience more significant improvements compared to those treated with VT alone. More studies in this area are recommended to better determine the effects of KT in MTD patients especially for long term effects of KT.

The effects of Cricothyroid Visor Maneuver (CVM) therapy on the voice characteristics of patients with muscular tension dysphonia: A Case Series Study

OBJECTIVE

The purpose of this study was to assess the effects of a novel manual therapy, the Cricothyroid visor maneuver (CVM) therapy, on acoustic, auditory perceptual and self-assessment ratings in Muscle tension dysphonia (MTD) patients.

STUDY DESIGN

This was a retrospective study of 6 clinical cases.

MATERIALS AND METHOD

The study comprised 6 Persian speakers with MTD (2 men and 4 women) and mean age 38.50 ± 5.32 years. All patients underwent therapy between April and June 2021. Therapy was provided in five 30-minute sessions. This study used of acoustic measurement including smoothed cepstral peak prominence (CPPs), Dysphonia Severity Index (DSI), self-assessment scales include vocal tract discomfort scale (VTD), voice related quality of life (V-RQOL) and Consensus Auditory- Perceptual Evaluation of Voice (CAPE-V) for auditory perceptual assessment in pre- and post-CVM sessions.

RESULTS

In the present study the CPPs and DSI increased while only CPPs significantly changed in pre and post therapy (P < 0.05). Also, having done the therapy the total severity of dysphonia (CAPE-V) and VTD significantly decreased (P < 0.05) and V-RQOL significantly increased (P < 0.05).

CONCLUSIONS

These results suggest that CVM can be an effective method for promote significant improvements in acoustic measurements, auditory perceptual and self-assessment scales in patients with MTD.

Evaluating the use of baclofen as adjunct treatment for muscle tension dysphonia

OBJECTIVE

To explore whether use of baclofen as adjunct treatment to voice therapy (VT) led to improvement in subjective throat symptoms in patients with primary muscle tension dysphonia (MTD). MTD is associated with excessive paralaryngeal muscle contraction, and baclofen is a muscle relaxant.

STUDY DESIGN

Cross-sectional, questionnaire-based study.

METHODS

An initial pool of patients, who were diagnosed with primary MTD and received 1+ VT session(s) at a single tertiary-care center from 2015 to 2019, were placed into either a baclofen group (prescribed 10 mg baclofen t.i.d. PRN along with VT) based on symptomatology or non-baclofen group (VT alone). They were administered questionnaires via postage mail or phone that included the Voice Handicap Index-10 (VHI-10), Reflux Symptom Index (RSI), and other survey elements. A retrospective chart review collected demographic and other clinical data from recruited participants.

RESULTS

A total of 314 non-baclofen and 63 baclofen patients met the inclusion criteria of this study, with 37 non-baclofen patients (mean age = 47.5 years, 62.2% female) and 15 baclofen patients (mean age = 45.5 years, 73.3% female) recruited. There was no significant difference in mean [SD] VHI-10 scores (11.30 [8.20] vs. 12.60 [10.75]; p = 0.638) and RSI scores (13.46 [10.44] vs. 16.20 [10.65]; p = 0.398) between non-baclofen and baclofen groups, respectively.

CONCLUSION

There was no significant difference in voice psychometric outcomes between non-baclofen and baclofen groups, measured primarily by the VHI-10 and RSI questionnaire components. Further studies are warranted to assess the efficacy and safety of baclofen as a therapeutic option for MTD.

Proteomic Characterization of Senescent Laryngeal Adductor and Plantaris Hindlimb Muscles

OBJECTIVES

The goals of this study were to 1) compare global protein expression in muscles of the larynx and hindlimb and 2) investigate differences in protein expression between aged and nonaged muscle using label-free global proteomic profiling methods.

METHODS

Liquid chromatography-mass spectrometry (LC-MS/MS) analysis was performed on thyroarytenoid intrinsic laryngeal muscle and plantaris hindlimb muscle from 10 F344xBN F1 male rats (5 old and 5 young). Protein expression was compared and pathway enrichment analysis performed for each muscle type (larynx and limb) and age group (old and young muscle).

RESULTS

Over 1,000 proteins were identified in common across both muscle types and age groups using LC-MS/MS analysis. Significant age-related differences were seen across 107 proteins in plantaris hindlimb and in 19 proteins in thyroarytenoid laryngeal muscle. Bioinformatic and enrichment analysis demonstrated protein differences between the hindlimb and larynx may relate to immune and stress redox responses and RNA repair.

CONCLUSION

There are clear differences in protein expressions between the laryngeal and hindlimb skeletal muscles. Initial analysis suggests differences between the two muscle groups may relate to stress responses and repair mechanisms. Age-related changes in the thyroarytenoid appear to be less obvious than in the plantaris. Further in-depth study is needed to elucidate how aging affects protein expression in the laryngeal muscles.

LEVEL OF EVIDENCE

NA Laryngoscope, 132:148-155, 2022.

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

BACKGROUND/PURPOSE

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.

METHODS

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.

RESULTS

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).

CONCLUSION

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.

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

PURPOSE

The purpose of this study was to determine the feasibility of altering speech breathing patterns and dysphonia severity through training increased levels of lung volume use during speech. It was hypothesized that respiratory-based training would increase lung volume levels during speech as well as improve acoustic voice measures, and that the addition of laryngeal-based treatment would further improve voice acoustics by treatment completion.

METHOD

A multiple baseline, single subject design was replicated over six participants with primary muscle tension dysphonia as a preliminary investigation of novel respiratory treatment methods. Following four baseline probes (1-4), two phases of treatment were implemented over 6 weeks. Respiratory lung volume-based training (RLVT) and subsequent performance was probed at sessions 5 to 7 and laryngeal-based training was added to the RLVT and probed at sessions 8 to 10. Visual biofeedback was used during RLVT to assist the motor learning process. Respiratory outcome measures of lung volume initiation, termination and excursion were objectively measured using respiratory plethysmography (InductoTrace), and cepstral and spectral-based acoustic measures were also determined at each time point.

RESULTS

All participants showed improvement in one or more respiratory measures as well as reduced acoustic dysphonia severity following phase 1 of RLVT alone. Two participants achieved further marked improvement in acoustic voice measures after laryngeal-based training was added in phase 2 of treatment, but this was generally also accompanied by further improvement or stabilization of respiratory measures.

CONCLUSION

Results from this preliminary study support the feasibility of RLVT for improving speech breathing behavior, and suggest that RLVT alone can improve objectively measured dysphonia severity.

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

OBJECTIVES

One of the presumed etiologies of primary muscle tension dysphonia (MTD) is a respiratory-phonatory disruption resulting in poor phonatory airflow in speech; however, few data exist on the differences between vocally healthy adults and patients diagnosed with MTD. The goal of this study was to compare aerodynamic and acoustic measures of self-perceived vocally healthy adults with patients diagnosed with MTD.

STUDY DESIGN

Retrospective, observational, matched cohort study.

METHODS

Vocally healthy adults age 19-60 years were matched on age, gender, and body mass index (BMI) to patients diagnosed with MTD. Recorded samples of the first four sentences of The Rainbow Passage were analyzed for between-group differences in the following acoustic and aerodynamic dependent measures in connected speech: mean airflow during voicing, breath number, reading passage duration, inspiratory and expiratory durations, phonation time, inspiratory and expiratory volumes, cepstral peak prominence (CPP), CPP standard deviation (CPP SD), low to high ratio (L/H ratio), L/H ratio SD, CPP Fo, CPP Fo SD, cepstral spectral index of dysphonia, and dB sound pressure level (SPL).

RESULTS

One hundred and seventy participants were studied; 85 patients diagnosed with primary MTD and 85 vocally healthy control participants. The two groups differed significantly in mean SPL, duration of the reading passage, and inspiratory and expiratory airflow duration (P ≤ 0.003). No significant differences were observed between the groups on any other phonatory aerodynamic or acoustic measure. Mean SPL, duration of the reading passage, and inspiratory and expiratory airflow durations were lower and longer, respectively, in patients with MTD. Ranges and standard deviations were greater for all aerodynamic and acoustic measurements in patients with MTD.

CONCLUSION

Large variability in aerodynamic and acoustic measurements were observed in patients with primary MTD with no salient differences at the group level compared to vocally healthy participants. Individual phonatory aerodynamic and acoustic profiles should be used when setting goals for patient treatment plans and to track response to treatment for patients with MTD. Taken in its entirety, connected speech from patients diagnosed with MTD essentially reflect normal acoustic and aerodynamic values.

Efficacy of Voice Therapy in Improving Vocal Function in Adults Irradiated for Laryngeal Cancers: A Pilot Study

BACKGROUND

Radiation therapy (XRT) for laryngeal cancers causes acute and chronic vocal dysfunction. Although these deleterious effects of XRT are well-established, there is a dearth of research with respect to effective voice rehabilitation following XRT for laryngeal cancers.

OBJECTIVE

To obtain preliminary data on the efficacy of voice rehabilitation, using vocal function exercises (VFEs) in improving vocal function in adults irradiated for laryngeal cancer. The comparison treatment group (VH) received vocal hygiene counseling.

STUDY DESIGN

Randomized clinical trial.

METHODS

Participants were randomized to the VFE + VH or VH group. Both interventions lasted 6 weeks. The primary outcome measure was improvement in VHI scores. Secondary outcome measures included auditory-perceptual assessments, acoustic and aerodynamic measures, and laryngeal imaging.

RESULTS

Ten participants were recruited for the study. The VFE + VH (n = 6) group demonstrated a statistically significant improvement in the primary outcome measure (P = 0.03), as well as select parameters of all secondary outcome measures. The VH (n = 4) group did not demonstrate a statistically significant improvement in primary or secondary outcome measures.

CONCLUSIONS

This study offers preliminary data for the utility of VFEs in the irradiated laryngeal cancer population. However, findings in the VFE + VH group lack generalizability, secondary to sample heterogeneity, and limited sample size.

Applicability of Resonance Tube Phonation in Water for Semi-Occluded Vocal Tract Voice Training and Therapy

BACKGROUND

Exercises involving tube phonation in water (TPW) have emerged as an alternative to conventional voice therapy techniques. The objective was to determine whether the results of these techniques were comparable to each other for the treatment of voice pathology, as well as to compare the costs implicated in the delivery of each treatment.

METHODS

A retrospective, descriptive, and observational study was performed that included all patients evaluated in our voice unit in 2015 who received vocal rehabilitation treatments. They were divided into two groups depending on the treatment technique used. The patients' voice was evaluated subjectively using the GRBAS scale. We compared the clinical results and the specific costs of each technique.

RESULTS

A total of 55 patients were studied, of which 28 followed TPW exercises, and 27 underwent supervised vocal rehabilitation (SVR). Most of the patients who received TPW therapy were diagnosed with functional dysphonia, whereas functional-organic dysphonia was the most common pathology in the SVR group. Significant differences were evident when the total GRBAS scores were compared before and after the treatments, yet not when the GRBAS scores were compared between the two rehabilitation techniques. The incremental cost-effectiveness analysis revealed that TPW was less expensive than SVR, with both techniques proving to be equally effective in improving the pathological problems.

CONCLUSIONS

TPW is similarly effective as SVR techniques in treating voice pathologies, yet it is significantly cheaper in terms of healthcare costs.

Vocal function exercises for normal voice: With and without semi-occlusion

PURPOSE

This study examined the effect of varying degrees of vocal tract (VT) occlusion used during Vocal Function Exercises (VFEs) on attainment of maximum phonation time (MPT) goals in normal voice. Greater VT occlusion was expected to result in increased MPT. The overarching goal was to determine whether the semi-occluded vocal tract (SOVT) posture used during VFEs could be modified while preserving efficacy.

METHOD

Twenty-six females ages 18-30 participated in this pre-post longitudinal group study. Participants were randomly assigned to three experimental groups and completed a six-week VFE protocol. The first group performed exercises using the prescribed SOVT posture; the second group used the vowel /o/; group three used the vowel /a/. The primary outcome measure was MPT as performed on the exercise tasks using the assigned vocal tract posture.

RESULT

MPT significantly improved in the prescribed SOVT group, but did not significantly improve in the modified /o/ and /a/ groups.

CONCLUSION

The SOVT posture used during VFEs is modifiable to a small extent without significantly undermining efficacy. Changes in MPT are less robust with reduced VT occlusion. Research in a clinical population is warranted.

Vocal function exercises for normal voice: The effects of varying dosage

PURPOSE

This study examined the effect of varying dosage of vocal function exercise (VFE) home practice on attainment of pre-established maximum phonation time (MPT) goals in individuals with normal voice. High dosage VFE practice was expected to result in greatest MPT. The overarching goal of this study was to contribute to a VFE dosage-response curve, potentially including a point of observable toxicity.

METHOD

Twenty-eight females ages 18-25 with normal voice participated in this pre-post longitudinal group study. Participants were randomly assigned to one of three experimental groups and completed a six-week VFE protocol with practice twice daily. The low dosage group performed each exercise once, the traditional group twice, and the high dosage group four times. The primary outcome measure was MPT as performed on the fourth VFE using the prescribed semi-occluded vocal tract posture.

RESULT

No toxic effects were observed. MPT increased for all participants, with significant improvement for traditional and high dosage groups.

CONCLUSION

High dosage VFEs may yield more rapid improvement in MPT, however benefits must be weighed against the risk of increased attrition. Low dosage VFEs insufficiently improved MPT. Further research on dosage is warranted, and should include individuals with disordered voice.

Self-perception of quality of life in patients with functional voice disorders: the effects of psychological and vocal acoustic variables

PURPOSE

Functional voice disorders (FVD) are multifactorial and may have a significant impact on the patients' quality of life (QOL). The aim of this study was to explore and analyze the relationship between the VHI scores, psychological variables, and objective voice measurements, and to develop a psychological and/or vocal acoustic model for the overall self-perceived evaluation of quality of life for three different types of FVD.

METHODS

After ENT examination, 83 women were classified into three groups: psychogenic voice disorder (PVD = 39), primary muscle tension voice disorder (MTVD1 = 16), and secondary muscle tension voice disorder (MTVD2 = 28). All patients were evaluated according to a multidisciplinary assessment protocol, which included the self-evaluation of quality of life (Voice Handicap Index, VHI), psychological evaluation (Hamilton Rating Scales for Depression (HAM-D) and for Anxiety (HARS), and Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Auto questionnaire (TEMPS-A)), and vocal acoustic analysis [mean fundamental frequency (F0, Hz), jitter (local, %), shimmer (local, %), and harmonic-to-noise ratio (HNR, dB)].

RESULTS

Our findings revealed a moderate impact on QOL, regardless of the type of FVD. There were significant correlations between VHI scores, psychological variables, and voice perturbation parameters, with the exception of the MTVD1 and MTVD2 groups. The stepwise multiple linear regression analysis suggested that QOL could be explained by: anxious temperament together with shimmer in PVD group, jitter in the MTVD1 group, and depressive temperament in the MTVD2 group.

CONCLUSIONS

Affective temperaments and/or voice perturbation parameters were meaningful predictors of self-evaluation of quality of life in patients with different types of FVD.

Preliminary study of Novafon local vibration voice therapy for dysphonia treatment

Background: The objective of this study was to explore the effectiveness of a five-week Novafon local vibration voice therapy (NLVVT) program for dysphonia treatment.Methods: Eleven dysphonic subjects participated in this specific program.Results: Treatment effects were assessed during (i.e. weekly) and after NLVVT. Large and significant treatment effects were revealed in acoustics (i.e. spectrography), and multiparametric indices (i.e. Acoustic Voice Quality Index (AVQI), and Dysphonia Severity Index (DSI)) during and after NLVVT (all p values < .01). Additionally, self-evaluation (i.e. Voice Handicap Index (VHI)) showed a significant improvement after NLVVT (p < .01). Gender independent voice range profile parameters (i.e. acoustics) only showed significant effects after treatment (p ≤ .01), but not during the treatment. Finally, aerodynamic measurement (i.e. phonation quotient) showed low treatment effects after NLVVT, which were not significant (p > .05).Conclusions: The preliminary results showed that NLVVT might be successful in voice treatment. Large treatment effects might be expected in AVQI, DSI, spectrography and VHI after using NLVVT. Other voice characteristics showed smaller treatment effects (i.e. voice range profile parameters) or no meaningful treatment effects (i.e. phonation quotient).