Acceptability, reliability, and validity of the Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39) across languages: a systematic review.

OBJECTIVES: This systematic review aimed to explore the acceptability, reliability, and validity of the Stroke and Aphasia Quality of Life-39 (SAQOL-39) scale across languages. DATA SOURCES: We employed a systematic search of the online databases including MEDLINE (Pubmed), Science direct, Web of science, Psychinfo, Scopus, ProQuest, Google Scholar, and Cochrane library published between 2003 and 2016. REVIEW METHODS: We used PRISMA guidelines for conducting and reporting this review. Subsequently, screening of the titles and abstracts, extraction of data as well as the appraisal of the quality of relevant studies were carried out. RESULTS: The initial search returned 8185 studies. Subsequent screening and study selection processes narrowed them to 20, needing detailed review. Forward-backward translation scheme was the preferred method for translation of the SAQOL-39 from English to other languages. Mainly, the socio-cultural and linguistic adaptations were performed in the translated versions. Most versions of the SAQOL-39 showed high test-retest reliability and internal consistency. However, several psychometric properties including the validity and responsiveness were seldom reported in these versions. CONCLUSION: The SAQOL-39 scale showed high acceptability, and reliability across the languages reviewed in this study. Future translations may additionally focus on reporting the validity and responsiveness of the instrument.

Vocal Tract Discomforts among Smokers.

INTRODUCTION: Smoking is a dangerous behavior for the human body and the vocal tract. Smoking can cause several laryngeal and vocal tract symptoms in smokers. One of these symptoms can be physical discomfort experienced by this population. Therefore, the aim of the present study was to investigate vocal tract discomfort (VTD) in smokers compared to healthy non-smoker participants. MATERIALS AND METHODS: The smokers group was forty-eight men with a mean age of 47.54 ± 9.21 years, and the matched non-smokers group was 48 men with a mean age of 44.88 ± 10.81 years. The participants underwent vocal tract discomfort assessment using the Persian version of the VTD scale. Statistical Package for the Social Science (SPSS) was used for statistical analysis and the Mann-Whitney U test was used to compare variables between groups. RESULTS: The smokers more frequently had VTD symptoms (P < 0.05) than non-smokers for all items of the VTD scale with the exception of aches. Also, smokers had more significant VTD severity in all items than non-smokers (P < 0.05). Moreover, there were significant statistical differences between the total score of both frequency and severity of VTD between smokers and non-smokers. The most to the least VTD symptoms in smokers were irritation, sore, tickling, burning, tightness, lump in the throat, dry, and aching symptoms, respectively. CONCLUSION: The present study suggests that smoking can cause more physical vocal tract discomfort in smokers compared to non-smokers. These results can inform future research and interventions in the smoker population.

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.

OBJECTIVES: The purpose of the present study was to examine the effect of adding a cricothyroid visor maneuver to conventional voice-facilitating techniques on voice quality and reported symptoms in patients with primary muscle tension dysphonia. METHODS: This was a double-blind two parallel-group clinical trial in which 20 adult patients participated through convenience sampling. Participants were allocated to intervention (combined treatment) and control (conventional treatment) groups. The intervention was performed for both groups for five sessions, twice a week. The two groups were compared after the intervention for primary outcome measures including maximum phonation time, jitter, shimmer, harmonic-to-noise ratio, and consensus auditory-perceptual evaluation of voice, and for secondary outcome measures including the voice handicap index, the voice activity and participation profile, the voice-related pain scale, and the vocal tract discomfort scale. RESULTS: Within-group primary outcome comparison showed that both groups showed significant improvement in maximum phonation time and consensus auditory-perceptual evaluation of voice indices after treatment. the between-group comparison showed that the maximum phonation time increased significantly in the intervention group after the treatment (P = 0.03) and the effect size was large (es = 1.05). within-group secondary outcome comparison showed that all indices improved significantly in both groups except for the voice-related pain scale frequency. The between-group comparison showed that except for voice-related pain scale frequency, the intervention group reported significantly more improvement in all other self-reporting indices with a large effect size. CONCLUSIONS: The study showed that adding cricothyroid visor maneuver to conventional voice-facilitating techniques, compared to conventional treatment alone, resulted in a significant increase in maximum phonation time, reduction in pain and vocal tract discomfort, increase in activity and participation, and improvement in voice-handicapped index in primary muscle tension dysphonia patients. Therefore adding cricothyroid visor maneuver to other treatments can be an effective method in improving primary muscle tension dysphonia which needs more studies in the future.

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.

The Persian version of the Functional Oral Intake Scale (FOIS-P): a validation study on stroke patients with dysphagia.

PURPOSE: The present study aimed to validate the Persian version of the Functional Oral Intake Scale (FOIS-P) for stroke patients. MATERIALS AND METHODS: The current study was conducted in two phases: (1) translation and cross-cultural adaptation of the FOIS into Persian and (2) validation of the FOIS-P. Phase 1 included forward translation, synthesis, back-ward translation, expert panel, and pretesting. To validate the FOIS-P, inter-rater reliability, cross-validity, and sensitivity to change of the scale were investigated. To evaluate the inter-rater reliability of the FOIS-P, two speech-language pathologists, who were blind to the study aims and procedure, applied the FOIS-P to assess the oral intake of 60 stroke survivors. The cross-validity was assessed by investigating the correlation between the FOIS scores and the Video Fluoroscopy Swallowing Study (VFSS). Also, we applied the FOIS-P on 60 patients with stroke at three different times to investigate the sensitivity to change. RESULTS: Inter-rater reliability of the FOIS-P was excellent according to Cohen's Kappa calculation (K = 0.89, p<.001). Investigation of cross-validity showed that there were significant correlations between the FOIS scores and presence of dysphagia, presence of aspiration, and severity of dysphagia (p<.001). The changes of the FOIS-P scores over follow-ups revealed that the FOIS-P was sensitive to the patient's oral intake changes. CONCLUSIONS: The FOIS-P is a valid and reliable tool for assessing oral intake in stroke survivors with dysphagia. Hence, the FOIS-P may be suitable for clinical and research in the field of stroke.

Development and psychometric evaluation of a scale to measure telepractice among speech and language pathologists during COVID-19 pandemic.

PURPOSE: With the outbreak of the COVID-19 and the need for physical distancing, the provision of Speech-Language Pathology (SLP) services via telepractice has been essential. One of the first steps in this field is the need to study telepractice among Speech and Language Pathologists (SLPs). However, there is currently no specific instrument to measure telepractice in SLP to achieve this aim. The present study was conducted to develop and evaluate the psychometric properties of a questionnaire to investigate telepractice among SLPs during the COVID-19 pandemic. MATERIALS AND METHODS: The study comprised of two stages: (1) development of the questionnaire according to an in-depth literature review and (2) evaluation of the validity and reliability of the questionnaire. The content validity of the instrument was determined by 10 experts in the field of SLP. To check the face validity of the questionnaire, 10 SLPs were interviewed and their opinions were incorporated in the questionnaire. A total of 221 SLPs completed the questionnaire to determine the construct validity and the internal consistency. To evaluate the test-retest reliability, 30 SLPs completed the questionnaire twice with two weeks of interval. RESULTS: The final version of the questionnaire comprised of three sections and 31 items. The Cronbach's alpha coefficients for different sections of the questionnaire ranged between 0.902 and 0.92 and the Intra-class Correlation coefficients of the sections were found to be between 0.9 and 0.96 in the test-retest reliability. CONCLUSIONS: The questionnaire developed in the study is a valid and reliable scale to measure telepractice among SLPs for educational or research purposes.

Laryngeal and Voice Symptoms of Workers in a Chlorine Chemical Factory.

OBJECTIVE: Exposure to chlorine gas can cause many problems for people who work in chlorine chemical production factories. The present study was conducted to investigate the prevalence of laryngeal and voice symptoms and related factors among workers in a chlorine chemical production factory. DESIGN: A case-control study. PATIENTS AND METHODS: A total number of 208 workers, including 138 workers (13 females, 125 males) who work in a chlorine chemical production factory and 70 (three females, 67 males) workers of a non-chlorine producing factory (producing metal materials), participated in the study. All participants completed self-reported questionnaires to investigate laryngeal or voice problems. These questionnaires investigated workplace vocal health, presence of voice or laryngeal problems, voice symptoms and laryngeal discomforts, and complications of voice problems. RESULTS: The prevalence of laryngeal or voice problems in the workers of the chlorine factory group (18.8%) was higher than in the control group (7%) and this difference was statistically significant (P = 0.018). For all of the voice and laryngeal symptoms, workers in the chlorine factory had more symptoms than workers in the control group. Results of a Chi-Square test showed that workers in the chlorine factory had more significant vocal fatigue and dry throat symptoms than the control group (P < 0.05). Regression logistic analyses showed that age (P = 0.008; OR = 1.09; CI = 1.02-1.17), inadequate humidity (P = 0.015; OR = 2.78; CI = 1.21-6.38), and unavailability of water (P = 0.021; OR = 3.80; CI = 1.22-11.76) raised the chances of increasing the laryngeal and voice symptoms among workers. The most common side effects of laryngeal symptoms and voice problems for workers were: difficulty speaking in crowded environments, low self-esteem while talking, need for repetition to understand speech, and anxiety when speaking. CONCLUSION: Laryngeal and voice problems were more prevalent in the chlorine factory workers group than in the control group. The factors of age, inadequate humidity, and unavailability of water increased the probability for laryngeal or voice symptoms among chlorine factory workers. These findings indicate the need for further research with this population.

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.

Development and Preliminary Validation of a Pain Scale Specific to Patients With Voice Disorders: The Voice-Related Pain Scale (VRPS).

INTRODUCTION: Although pain is one of the complaints reported by voice patients, still there is no valid and reliable scale to evaluate pain in Patients with Voice Disorders (PWVDs). Therefore, the aim of the present study was to develop and validate the Voice-Related Pain Scale (VRPS). METHODS: The present study was conducted in two stages: (1) development of the VRPS based on semistructured interviews with PWVDs and experts in the field of voice disorders and an in-depth literature review, and (2) Evaluation of the psychometric properties of the VRPS. Determining the validity and reliability of the VRPS was performed using qualitative and quantitative content validity, the qualitative face validity, and the test-retest reliability. Content validity of the VRPS was assessed by Speech and Language Pathologists who are experts in the assessment and treatment of voice patients and laryngologist. The reliability of the scale was determined using test-retest reliability. RESULTS: Based on the interviews with PWVDs and experts, and a thorough review of the related literature, a self-reported scale with 11 items and three sections was developed. The three items included ear, temporomandibular joint, and shoulder all of which were divided into right and left pairs based on the experts' suggestion. One item was eliminated because it had a content validity ratio less than 0.62. The content validity index (CVIs) for all the remaining items were higher than 0.79 and the scale content validity index was equal to 0.93. The test-retest reliability was satisfactory with weighted kappa ranging from 0.64 to 1 for VRPS items. The final version of the VRPS comprised of 13 items related to the pain location in the human body. Each of these items has three sections: frequency of pain, severity of pain, and time of pain occurrence. CONCLUSION: The present study indicated that VRPS is a valid and reliable tool to evaluate pain in PWVDs. The VRPS is a useful tool for clinical and research purposes. However, more studies are needed in this regard for further evaluation of the VRPS.

Development and evaluation of the psychometric properties of the caregiver burden scale for parents of children who stutter (CBS-PCWS).

PURPOSE: Caring for a child who stutters can impose excessive pressure on parents. Caregiver burden affects many aspects of parents' lives. Paying attention to parents in the treatment of children who stutter (CWS) is important because parents play a key role in the treatment of CWS. The aim of the study was to develop the Caregiver Burden Scale for Parents of Children Who Stutter (CBS-PCWS) and investigate the psychometric properties of the CBS-PCWS. METHOD: The CBS-PCWS was developed using interviews with 15 parents of CWS and a literature review. The content validity, face validity, construct validity using exploratory factor analysis (EFA), and reliability of the CBS-PCWS were investigated. The content validity was evaluated using 10 experts' opinions. Face validity was determined using interviews with 10 parents of CWS. The reliability of the CBS-PCWS was evaluated through internal consistency and test-retest reliability. RESULTS: The scale development resulted in the creation of 137 items. During an expert panel with the presence of the research team, 51 similar items were eliminated. During the qualitative content validity stage, nine items were added to the initial scale. After determining the content and face validity, the number of CBS-PCWS items was reduced to 52 items. In the construct validity stage using EFA with responses from 364 parents, eight items of the CBS-PCWS were removed due to low factor loadings. The results of the EFA indicated that the CBS-PCWS contained five factors: psychological and emotional, personal and physical, support for caregiving, culpability, and socio-communicative. The Cronbach's alpha values of the scale domains were in the 0.78-0.94 range. In addition, the ICC test-retest coefficient for the total score of the CBS-PCWS was 0.93 and for its domains was in 0.91-0.99 range. CONCLUSION: The CBS-PCWS has 44 items with five domains and is a valid and reliable scale that can be used for clinical or research purposes. More studies are required to evaluate further psychometric properties of the CBS-PCWS.

Voice Problems and Related Risk Factors Among Hairdressers.

OBJECTIVE: Hairdressers are more prone to respiratory diseases, bronchitis, asthma, shortness of breath, and cough due to the nature of their occupation and the constant use of cosmetics. Therefore, they may be prone to voice disorders or laryngeal problems. Voice problems may affect not only their social and emotional relationships but also their jobs. The current study was conducted to investigate voice problems and related risk factors in hairdressers. DESIGN: Cross-sectional, descriptive-analytical. PATIENTS AND METHODS: A total number of 293 women participated in the study. The study group consisted of 147 hairdressers and the control group consisted of 146 women with other jobs. All study participants were requested to complete a self-reported questionnaire. This questionnaire investigated demographic characteristics, voice problems and symptoms, laryngeal discomfort, working features, and workplace conditions. Chi-square, independent t-test, Fisher's exact test, and logistic regression were used to analyze the data. RESULTS: The prevalence of voice problems in hairdressers and the control group was 33.33% and 15.75%, respectively, and this difference was statistically significant (P < 0.001). Results of the Chi-Square test showed that prevalence of hoarseness, vocal fatigue, dryness, and cough were higher in hairdressers than the control group (P < 0.05). According to regression logistic results, work time (hours per week) (P = 0.014; OR = 2.35; CI = 1.18-4.66) and presence of phonotraumatic behaviors (P = 0.012; OR = 2.73; CI = 1.24-5.96) increased the possibility of increasing the presence of voice symptoms among hairdressers. CONCLUSION: The findings revealed that self-reported voice problems were more prevalent in the hairdressers group than in the control group and therefore the hairdressers were more prone to an increased risk of developing voice problems. The most common symptoms in the hairdressers group were cough, hoarseness, and dryness in the vocal tract. Based on these results, in addition to paying attention to recommendations related to environmental issues and exposure to chemical hazards, hairdressers may benefit from receiving appropriate training in voice production, voice disorders, and the prevention of voice disorders.

Determining pain in patients with voice disorders: a qualitative study.

AIM: The present study aimed to determine pain in patients with voice disorders (PWVDs). PATIENTS AND METHODS: A total number of 28 patients with a range of voice disorders and without any other diseases participated in the study. To gain maximum variation, purposive sampling method was used. Moreover, semi-structured interviews were employed for data collection. The interviews were then continued until data saturation was reached, and the data were subsequently recorded and transcribed verbatim. Qualitative content analysis was utilized for data analysis. RESULTS: Data analysis of the interviews emerged three themes about pain experienced by PWVDs. The emerged themes included location of pain, type of pain, and time of pain occurrence. In this respect, PWVDs reported pain in different locations on their body including head, ears, anterior neck, posterior neck, larynx, temporomandibular joint, submandibular area, shoulders, and upper back. Furthermore, chronic, acute, severe, and mild were the most common types of pain reported by PWVDs. The PWVDs also stated that they had experienced pain at different times, i.e. during speaking, after long-time speaking, after voice use, during swallowing, during palpation, and all the time (even at rest). CONCLUSIONS: One of the physical discomforts experienced by PWVDs is pain. According to the results of the present study, pain should properly be considered in the assessment and treatment of PWVDs in clinical practices. Also, our study suggested that a specific scale is needed to measure pain in voice disorders.

Voice Quality and Vocal Tract Discomfort Symptoms in Patients With COVID-19.

INTRODUCTION: Dysphonia and laryngeal problems are some of the manifestations of the COVID-19 pandemic due to respiratory disease as a primary effect of COVID-19. The aim of the present study was to investigate voice quality and vocal tract discomfort symptoms in patients with COVID-19. MATERIALS AND METHODS: Forty-four COVID-19 patients with a mean age of 49.61 ± 16.48 years and 44 healthy subjects with a mean age of 48.52 ± 13.8 years participated in the study. The voice quality of the participants was evaluated using auditory-perceptual evaluation with the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale. The vocal tract discomfort symptoms of the participants were assessed using the Persian version of the VTD scale. RESULTS: Patients with COVID-19 had higher scores in all items of the GRBAS, including grade, roughness, breathiness, asthenia, and strain, than healthy subjects, and these differences were statistically significant (P < 0.05). Among the GRBAS parameters, grade had the highest effect size and asthenia had the lowest effect size in both speech tasks. The COVID-19 patients had a greater frequency of vocal tract discomfort symptoms than healthy subjects in all items of the VTDp scale and these differences were statistically significant (P < 0.05) in the following items: burning, tight, dry, pain, sore, irritable, and lump in the throat. The most and the least effect size in frequency of the vocal tract discomfort symptoms were related to dry (d = 1.502) and tickling (d = 0.157), respectively. Also, COVID-19 patients had more significant severity in all items of the VTDp scale except tight and tickling. The most and the least effect size in severity of the vocal tract discomfort symptoms was related to dry (d = 1.416) and tickling (d = 0.152), respectively. CONCLUSION: The present study suggests that COVID-19 patients have more deviations in voice quality than healthy subjects. Moreover, mild vocal tract discomfort is prevalent in patients with COVID-19, and patients have more frequent and severe physical discomforts of the vocal tract than healthy subjects.

Provision of speech-language pathology services for the treatment of speech and language disorders in children during the COVID-19 pandemic: Problems, concerns, and solutions.

Recently, a novel virus has spread worldwide causing the disease called COVID-19. In addition to putting people's lives at risk and causing mortality, various problems have occurred due to the negative effects of the COVID-19 pandemic. Quarantine, social distancing, and the obligation to use protective tools have led to sometimes long term closing of various jobs and services, including rehabilitation services. For instance, the disease has interrupted the provision of Speech-Language Pathology (SLP) services to children due to the need for face-to-face communication between Speech and Language Pathologists (SLPs) and children during the evaluation and treatment processes. Therefore, here, we described the quality of providing SLP services during the COVID-19 pandemic and the negative effects of the disease on the provision of SLP services. In addition, we made an attempt to explain concerns and problems raised by the families, the importance of providing SLP services during the critical period of speech and language development, telepractice services, the roles of speech-language-hearing related scientific associations, and the roles of SLPs during the outbreak of COVID-19.

Application of High-Frequency Transcutaneous Electrical Nerve Stimulation in Muscle Tension Dysphonia Patients With the Pain Complaint: The Immediate Effect.

INTRODUCTION: The aim of the present study was to investigate the immediate effect of the application of high-frequency Transcutaneous electrical nerve stimulation (TENS) in muscle tension dysphonia (MTD) patients with the pain complaint. MATERIALS AND METHODS: Thirty patients with MTD, 10 men and 20 women with a mean age of 36.40 ± 5.76 years, participated in the study. The patients were randomized into two groups: (1) Treatment group (TENS) (10 women and 5 men) and (2) Sham TENS group (10 women and 5 men). The treatment group (TENS) received a unique 20-minute session of high-frequency TENS. The sham TENS group was treated in the same condition as the treatment group and received a unique 20-minute session of high-frequency TENS, but no stimulation was given. Auditory-perceptual assessments, acoustic voice analysis, vocal tract discomfort (VTD), and musculoskeletal pain were used to compare the patients pre- and post-treatment. RESULTS: There was a significant improvement in the asthenia parameter of auditory-perceptual assessment in the TENS group. This improvement in asthenia was significant when comparing the TENS group with the sham TENS group. These differences in the asthenia were not significant after using Holm-Bonferroni correction. A comparison of the VTD before and after the TENS application showed there was a significant reduction in the severity of the symptoms (burning, tight, dry, pain, tickling, sore, irritable, and lump in the throat). When comparing the TENS group with the sham TENS group, improvements in burn, tight, dry, pain, and irritable items of VTD were observed. However, after applying the Holm-Bonferroni correction, only reductions in dry and pain items remain significantly different between the groups. After the TENS application, the pain intensity was significantly reduced in the anterior and posterior neck, larynx, submandibular, masseter, temporal region, and upper back. After applying the Holm-Bonferroni correction, pain intensity reduction was significant in the anterior neck and larynx. When comparing the TENS group with the sham TENS group, pain intensity was reduced significantly in the larynx of the TENS group. This difference between the two groups was not significant after using Holm-Bonferroni correction. The pain and VTD assessments in the present study were performed using valid and reliable self-reported scales (NMSQ-E and VTD). CONCLUSION: High-frequency TENS can be used in the voice treatment program of patients with MTD. MTD patients with pain complaint reported that their vocal tract discomfort and pain were decreased following the high-frequency TENS. Notably, these positive effects were obtained after a single session of high-frequency TENS application.

Transcutaneous Electrical Nerve Stimulation Combined With Voice Therapy in Women With Muscle Tension Dysphonia.

OBJECTIVES: The purpose of the present study was to investigate the effect of Voice Therapy (VT) with and without Transcutaneous Electrical Nerve Stimulation (TENS) in women with Muscle Tension Dysphonia (MTD). METHODS: A total of 20 women with MTD participated in the study. Participants underwent evaluation of auditory-perceptual assessment, acoustic voice analysis, Vocal Tract Discomfort (VTD), and musculoskeletal pain before and after the treatment. The participants were divided into two groups: (1) TENS + VT group (10 participants) and (2) VT group (10 participants). Both groups received 10 sessions of treatment, twice a week, each lasting 50 minutes. The statistical analysis was performed using Wilcoxon signed ranked and Mann-Whitney U tests (P < 0.05). RESULTS: After VT, significant improvements were observed in all auditory-perceptual parameters and all VTD items except for the tickling frequency and severity. The VT caused significant reduction in the frequency of pain in anterior neck, posterior neck, and the larynx. Also, VT resulted in a significant reduction in pain intensity only in the larynx. After VT + TENS, significant improvements were observed in all auditory-perceptual parameters, shimmer, and all VTD items. Moreover, the VT + TENS led to a significant decrease in the frequency and intensity of pain in anterior neck, posterior neck, the larynx, masseters, shoulders, and upper back. The findings of between-group comparison after treatment showed significantly more reduction in the frequency (dry and pain items) and severity (tight and pain items) of the VTD in VT + TENS group compared with VT group. Regarding the musculoskeletal pain, significantly more reduction in the frequency and intensity of pain in anterior neck and the larynx was observed in VT + TENS group compared with VT group. CONCLUSIONS: The VT and VT + TENS could lead to positive outcomes in auditory perceptual assessment, acoustic voice analysis, the VTD, and assessment of musculoskeletal pain. In some items of frequency and severity of VTD scale and assessment of musculoskeletal pain, VT + TENS also produced better results compared with VT. As a result, TENS was recommended as a complementary therapy for patients with MTD, especially when these patients had more complaints about VTD and musculoskeletal pain.

Effects of Voice Therapy on Vocal Tract Discomfort in Muscle Tension Dysphonia.

INTRODUCTION: Patients with muscle tension dysphonia (MTD) suffer from several physical discomforts in their vocal tract. However, few studies have examined the effects of voice therapy (VT) on the vocal tract discomfort (VTD) in patients with voice disorders. Therefore, the aim of the present study was to investigate the effects of VT on the VTD in patients with MTD. MATERIALS AND METHODS: This study was carried out on 25 subjects with MTD, including 5 men and 20 women, with the mean age of 37.20±5.70 years. The participants underwent 10 consecutive sessions of VT twice a week. The acoustic voice analysis, auditory-perceptual assessment, and the Persian version of the vocal tract discomfort (VTDp) scale were used to compare the pre- and post-treatment results. RESULTS: After VT, significant improvements were observed in the acoustic characteristics, including jitter, shimmer, and harmonics-to-noise ratio (P<0.05). Regarding the auditory-perceptual assessment, a significant reduction was noticed in the overall severity, roughness, and breathiness (P<0.05). Moreover, VT led to a significant reduction in all the items of the VTDp, including burn, tightness, dryness, pain, tickling, soreness, irritability, and lump in the throat, after VT in both frequency and severity sections of the VTDp scale (P<0.05). CONCLUSION: The results of the present study showed that VT can be effective in reducing the frequency and severity of the VTD in patients with MTD in addition to improving voice quality.

Nonmedical Treatments of Vocal Fold Nodules: A Systematic Review.

OBJECTIVES: The aim of the present systematic review was to investigate the nonmedical treatments of vocal fold nodules (VFNs). STUDY DESIGN: The present study is a systematic review. METHODS: The following electronic databases were searched from inception until August 2016: PubMed, Scopus, ScienceDirect, Ovid, ISI (Web of Sciences), Cochrane, PsychINFO, The Cochrane Central Register of Controlled Trials, and Google Scholar. Reference lists of included articles were evaluated for additional data. Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were used to carry out and report the review. The methodological quality of the articles included was evaluated using the Physiotherapy Evidence Database scale. Due to the heterogeneity of the studies, a narrative synthesis of the evidence was performed to summarize the evidence. RESULTS: Out of 2,099 records identified, 21 articles met the inclusion criteria and thus were included in the review. The studies investigated in the present review were different in terms of study design, participant characteristics, types of assessments and treatments, and treatment delivery. However, nonmedical treatments of VFNs were found to be successful in improving vocal quality, decreasing VFN sizes, and resolving these nodules. CONCLUSIONS: The results of the present review could provide primary evidence related to the effectiveness of nonmedical treatment of VFNs. Yet further studies with a high level of evidence, a rigorous methodological quality, and long-term follow-up evaluations are required to make stronger claims.