The comparison between vocal facilitating techniques, manual circumlaryngeal therapy, and combined voice therapy in teachers with muscle tension dysphonia: a randomized clinical trial.

PURPOSE: Although voice therapy (VT) has been known effective in muscle tension dysphonia (MTD), it is not obviously clear which VT approach is more effective. This study aimed to compare the effectiveness of Vocal Facilitating Techniques (VFTs), Manual Circumlaryngeal Therapy (MCT), and combined VT in teachers with MTD. METHODS: This study was a double-blind parallel randomized clinical trial. Thirty elementary female teachers with MTD were divided into three treatment groups including VFTs; MCT, and combined VT. In addition, vocal hygiene was presented to all groups. All participants received 10 individual 45-min sessions of VT twice a week. The effectiveness was assessed using Vocal Tract Discomfort (VTD) scale and Dysphonia Severity Index (DSI) before and after treatment and improvement measurement was calculated. The participants and data analyzer were blinded to the type of VT. RESULTS: All groups showed significantly better results on the subscales of VTD scale and DSI score after VT (p ≤ 0.001; η2 ≥ 0.90). There was a significant difference between the three groups on the results of VTD scale and DSI score (p ≤ 0.05). The improvement measurement on the VTD severity subscale and DSI score following the combined VT was the greatest compared with other groups (η2 = 0.99 and 0.98, respectively). The significant interactive effect of treatment and time was observed on the VTD severity subscale and DSI score (p < 0.05; η2 ≥ 0.56). CONCLUSIONS: This study showed that the VFTs, MCT, and combined VT were effective for MTD teachers, and the combined VT is the most effective one. It seems the combination of different approaches is recommended for the VT of MTD patients.

A Study of Vocal Facilitating Techniques Compared to Manual Circumlaryngeal Therapy in Teachers With Muscle Tension Dysphonia.

OBJECTIVE: There are several voice therapy techniques been suggested in patients with muscle tension dysphonia (MTD), however a few studies are compared between them. The purpose of present study was to compare the effect of vocal facilitating techniques (VFTs) and manual circumlaryngeal therapy (MCT) in teachers with MTD. STUDY DESIGN: This is a randomized clinical trial study. METHODS: Sixteen teachers with MTD (female; mean age: 38.6 ± 4.6 years) participated in this study. The participants allocated to two treatment groups: the first group received VFTs (n: 8) and MCT was presented to the second one (n: 8). In each group, the voice therapy techniques were given for 10 individual sessions twice a week. The effect of both techniques was assessed using voice handicap index (VHI) and dysphonia severity index (DSI). RESULTS: Within group comparison, the VHI, DSI, and theirs components showed significantly better results after both treatment groups (P ≤ 0.05). Although, effect size was strong for all target features (η2 > 0.36); the greatest magnitude was obtained on the physical subscale of VHI following MCT and for the DSI after VFTs (η2 = 0.92 and 0.90, respectively). Moreover, the interactive effect of time and treatment groups indicated that there was significant main effect on the physical and functional subscales of VHI (P = 0.00 and 0.02, respectively) as well as I-low and DSI (P = 0.01 and 0.02, respectively). CONCLUSION: VFTs and MCT are two effective techniques in voice therapy of teachers with MTD. However, the greatest improvement obtained on the DSI following VFTs and for the physical aspect of VHI after MCT demonstrated voice therapist can use appropriate technique based on the voice complaints and results of voice assessments in MTD.

Responsiveness of Persian Version of Consensus Auditory Perceptual Evaluation of Voice (CAPE-V), Persian Version of Voice Handicap Index (VHI), and Praat in Vocal Mass Lesions with Muscle Tension Dysphonia.

OBJECTIVES: This study was aimed at determining the internal and external responsiveness of the Persian version of the Consensus Auditory-Perceptual Evaluation of Voice (called ATSHA), Persian version of the Voice Handicap Index (VHI), and Praat scales among patients with vocal mass lesions and secondary muscle tension dysphonia. STUDY DESIGN: Prospective, within-participant repeated measures. METHOD: Thirty patients with vocal fold nodules, polyps, and cysts related to secondary muscle tension dysphonia participated in the study. The measures of interest and videostroboscopy examination were used before and after treatment. The Global Perceived Effect questionnaire was used to separate those improved (moderately or greatly improved) and stable (slightly improved) patients. RESULTS: The mean standardized response, standardized effect size, and Guyatt analyses indicated high internal responsiveness for the all target parameters of the ATSHA, total score of the VHI, and two parameters of the Praat (0.8<). There was poor correlation between the videostroboscopy and the other target scales (r Pearson = -0.1-0.1). The receiver operating characteristic analysis indicated that all the target scales did not significantly separate those improved and stable subjects (area under the curve = 0), except for the overall severity and roughness parameters of the ATSHA scale (area under the curve = 1). CONCLUSION: This study recommends both the Consensus Auditory-Perceptual Evaluation of Voice and the VHI scales to show voice therapy changes. The target voice scale changes were not able to predict the videostroboscopy changes as external standard. Furthermore, we recommend that the overall severity and roughness may properly classify those improved and stable patients.

Does Opium Dependency Affect the Pattern of Involvement in Laryngeal Cancer?

INTRODUCTION: Laryngeal cancer is the second most common cancer involving the respiratory tract, second only to lung cancer. Previous studies have shown opium dependency to be a possible risk factor for laryngeal cancer. Opium consumption is a major problem in some parts of the world. The aim of this study was to investigate the effect of opium consumption on the pattern of involvement in laryngeal cancer. METHODS AND MATERIALS: In this analytical cross-sectional study, 44 patients diagnosed with laryngeal cancer (41 male and three female) were studied. Data were collected using a questionnaire, physical examination, and paraclinical studies. Patients were defined as opium dependent based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) criteria and duration of opium consumption. RESULTS: Patients were categorized into two groups: opium-dependent (32.6%) and non-opium-dependent (67.4%) patients. The average age of the patients was 58.5±3.2 years in the opium-dependent group and 60.7±2.8 years in the non-opium-dependent group (P=non-significant). An analysis of the pattern of involvement in each group showed glottis involvement in 56%, subglottis involvement in 8%, supraglottis involvement in 32%, and hypopharyngeal involvement in 4% of the opium-dependent group compared with glottis involvement in 55.9%, subglottis involvement in 11.8%, supraglottis involvement in 32.4%, and hypopharyngeal involvement in none of the non-opium-dependent group (P=non-significant). CONCLUSION: There was a poor correlation between opium dependency and pattern of involvement in laryngeal cancer. Opium dependency did not lead to the development of laryngeal cancer at a younger age, based on our study.