Effect of Akson Therapy on Acoustic Parameters in Patients with Functional Dysphonia.

OBJECTIVE: Functional dysphonia can impair the language expression ability and adversely affect the career development of some patients. Therefore, an active exploration of effective treatment options is imperative. This study investigated the effect of Akson therapy on acoustic parameters in patients with functional dysphonia. MATERIALS AND METHODS: In this retrospective analysis, 79 patients with functional dysphonia who received conventional voice correction training from June 2020 to June 2021 were included in the reference group (RG). Our hospital has implemented Akson therapy since July 2021. Correspondingly, 72 patients with functional dysphonia who underwent Akson therapy from July 2021 to July 2022 were enrolled in the observation group (OG). The acoustic parameters such as fundamental frequency (F0), jitter, shimmer, and normalized noise energy (NNE); the aerodynamic parameters including maximum phonation time (MPT), mean airflow rate (MFR), and Voice Handicap Index-10 (VHI-10) score; and the Grade, Roughness, Breathiness, Asthenia, and Strain scale (GRBAS) score were measured before and after treatment and compared between the two groups. RESULTS: The F0, jitter, shimmer, NNE, MPT, and MFR values as well as the VHI-10 score and the grade (G), roughness (R), and breathiness (B) scores on the GRBAS did not significantly differ between the two groups before treatment (P > 0.05). However, significantly lower F0, jitter, shimmer, NNE, and MFR values and higher MPT levels were found in the OG compared to the RG after treatment (P < 0.001). Furthermore, the VHI-10 score and the G, R, and B scores were significantly lower in the OG than in the RG after treatment (P < 0.001), whereas the asthenia (A) and strain (S) scores remained at 0 before and after treatment. CONCLUSION: Akson therapy can improve the acoustic parameters of patients with functional dysphonia to a certain extent, indicating its potential application value.

Squamous Cell Carcinoma of the Supraglottis Presenting as Hoarseness.

Hoarseness is a well-known condition in primary care offices, with over 1% of primary care visits secondary to this ailment.1 The most common causes are acute laryngitis (40%), functional dysphonia (30%), benign and malignant tumors (2.2 to 30%), neurogenic factors such as vocal cord paralysis (8%), physiological aging (2%), and psychogenic factors (2.2%). Most of these cases are secondary to viral infections and do not require antibiotics on most occasions. These viral infections subside after 1 to 2 weeks, and in the case of persistent hoarseness (above 4 weeks) the American Academy of Otolaryngology recommends direct visualization with a laryngoscopy before treatment with proton pump inhibitors, antibiotics, or steroids. Our patient presented with prolonged hoarseness (greater than eight weeks) but had a quick turn around time interval between primary care visit and laryngoscopy evaluation (less than 2 weeks). This led to her diagnosis and treatment with chemo and radiation therapy within three months of diagnosis with Squamous Cell Carcinoma of the Supraglottis. The Primary care physician serves as the number one point of visitation by sufferers of hoarseness. It is important that they are knowledgeable and up to date with recommendations and guidelines for managing this condition, as unwarranted delay can affect overall outcome on the part of the patient. This is especially important in patients such as ours with high risk factors including Nicotine dependence, alcohol use, asbestos exposure, and HPV infection.

La voix rauque est une condition bien connue dans les cabinets de soins primaires, avec plus de 1 % des visites en soins primaires dues à ce problème. Les causes les plus courantes sont la laryngite aiguë (40%), la dysphonie fonctionnelle (30 %), les tumeurs bénignes et malignes (2,2 à 30 %), les facteurs neurogènes tels que la paralysie des cordes vocales (8 %), le vieillissement physiologique (2 %) et les facteurs psychogènes (2,2 %). La plupart de ces cas sont dus à des infections virales et ne nécessitent pas d'antibiotiques dans la plupart des cas. Ces infections virales disparaissent après 1 à 2 semaines, et en cas de voix rauque persistante (plus de 4 semaines), l'American Academy of Otolaryngology recommande une visualisation directe avec une laryngoscopie avant le traitement par inhibiteurs de la pompe à protons, antibiotiques ou stéroïdes. Notre patiente présentait une voix rauque prolongée (plus de huit semaines), mais a bénéficié d'un délai rapide entre la visite en soins primaires et l'évaluation par laryngoscopie (moins de 2 semaines). Cela a conduit à son diagnostic et à son traitement par chimiothérapie et radiothérapie dans les trois mois suivant le diagnostic de carcinome épidermoïde du supraglotte. Le médecin de soins primaires est le premier point de visite pour les personnes souffrant de voix rauque. Il est important qu'ils soient informés et à jour des recommandations et des lignes directrices pour la prise en charge de cette condition, car un retard non justifié peut affecter le résultat global pour le patient. Ceci est particulièrement important chez les patients comme le nôtre présentant des facteurs de risque élevés, y compris la dépendance à la nicotine, la consommation d'alcool, l'exposition à l'amiante. MOTS-CLÉS: Laryngoscopie, Supraglotte, Larynx, Enrouement.

Indications and Short-Term Outcomes for In-Office Therapeutic Superior Laryngeal Nerve Block.

OBJECTIVE: Superior laryngeal nerve (SLN) block consists of injection of steroid and anesthetic at the internal branch of the SLN entry site. Prior case series have demonstrated beneficial effects on neurogenic cough. SLN blocks have also recently shown benefit for paralaryngeal pain. We describe short-term outcomes for multiple symptoms of irritable larynx syndrome (ILS) including neurogenic cough, dysphonia related to laryngeal hypersensitivity, inducible laryngeal obstruction (ILO), paralaryngeal pain, and isolated globus. METHODS: Retrospective review from 2 institutions of patients undergoing a single SLN block for the indications listed. Variables include age, sex, indication(s), known vagus neuropathy, and patient-reported outcomes at short-term follow-up. RESULTS: A total of 209 patients were included (59 males, 150 females; age: 58 ± 13 years). Twenty-six patients (12%) had a history of a vagus nerve injury. Indications included neurogenic cough (n = 149), dysphonia related to laryngeal hypersensitivity (n = 66), paralaryngeal pain (n = 50), ILO (n = 23), and isolated globus (n = 3). Some patients had multiple indications. Significant improvements in patient-reported measures occurred after a single SLN block within 2 to 4 weeks for neurogenic cough (cough severity index; 25.2 ± 11.2 to 19.0 ± 12.8; P < .001), dysphonia (voice handicap index-10; 22.1 ± 12.2-18.0 ± 13.3; P = .005), and ILO (dyspnea index; 21.0 ± 14.9-14.7 ± 15.7; P = .017). Subjective pain improved in 23 of 39 patients with paralaryngeal pain. There was no observed improvement for isolated globus. Presence of known vagal neuropathy or therapy around the time of SLN block did not affect outcome. CONCLUSION: SLN block can be an effective component of treatment for a variety of ILS symptoms. Patients may experience some improvement after 1 injection. LAY SUMMARY: Symptoms of irritable larynx syndrome, such as neurogenic cough, paralaryngeal pain, inducible laryngeal obstruction, and dysphonia related to laryngeal hypersensitivity can be challenging to manage. In-office Superior Laryngeal Nerve blocks can serve as a quick, well tolerated, adjunctive treatment with positive short-term outcomes. LEVEL OF EVIDENCE: 4.

The Efficacy of the Manual Circumlaryngeal Therapy for Muscle Tension Dysphonia: A Systematic Review and Meta-analysis.

OBJECTIVE: Muscle tension dysphonia (MTD) is the most common functional voice disorder. Behavioral voice therapy is the front-line treatment for MTD, and laryngeal manual therapy may be a part of this treatment. The objective of this study was to investigate the effect of manual circumlaryngeal therapy (MCT) on acoustic markers of voice quality (jitter, shimmer, and harmonics-to-noise ratio) and vocal function (fundamental frequency) through a systematic review with meta-analysis. DATA SOURCES: Four databases were searched from inception to December 2022, and a manual search was performed. REVIEW METHODS: The PRISMA extension statement for reporting systematic reviews incorporating a meta-analysis of health care interventions was applied, and a random effects model was used for the meta-analyses. RESULTS: We identified 6 eligible studies from 30 studies (without duplicates). The MCT approach was highly effective on acoustics with large effect sizes (Cohen's d > 0.8). Significant improvements were obtained in jitter in percent (mean difference of -.58; 95% CI -1.00 to 0.16), shimmer in percent (mean difference of -5.66; 95% CI -8.16 to 3.17), and harmonics-to-noise ratio in dB (mean difference of 4.65; 95% CI 1.90-7.41), with the latter two measurements continuing to be significantly improved by MCT when measurement variability is considered. CONCLUSION: The efficacy of MCT for MTD was confirmed in most clinical studies by assessing jitter, shimmer, and harmonics-to-noise ratio related to voice quality. The effects of MCT on the fundamental frequency changes could not be verified. Further contributions of high-quality randomized control trials are needed to support evidence-based practice in laryngology. Laryngoscope, 134:18-26, 2024.

[Voice disorders associated with novel coronavirus infection]. / Narusheniya golosa u patsientov posle perenesennoi novoi koronavirusnoi infektsii.

OBJECTIVE: To evaluate the features of voice disorders associated with novel coronavirus infection and to develop the clinical algorithm for diagnostic and treatment these patients. MATERIAL AND METHODS: A prospective observational study was conducted in patients with dysphonia after COVID-19 (n=60). All patients underwent a comprehensive voice assessment before and after the proposed treatment. The follow-up period was 1 month. RESULTS: Functional dysphonia or aphonia with a stable (refractory) or recurrent course was diagnosed in 58 (97%) patients. A tendency to an increase in the value of the latent period of the P300 and MMN in patients with voice disorder was revealed. There was a significant decrease in supraglottic constriction and glottal insufficiency before and after the treatment. The mean VHI-10 decreased from 25.4 before treatment to 15.3 after treatment. The DSI which is based on the set of voice measurements, statistically significant improved from -5.2 to 2.6 in patients as a result of treatment. The average value of MFI-20 improved from 65.4 (8.7) at the beginning of the study to 20.3 (5.3) after treatment. CONCLUSION: In patients with dysphonia or aphonia associated with COVID-19 are indicated a refractory type of dysphonia. This was indicated by the study of AEPs of the brain. The clinical algorithm for treatment and diagnostic patients with voice disorders after COVID-19 has been developed. The treatment of this group of patients should be adjunct by the drug therapy, kinesiotaping method and psychotherapy.

[Application of the biofeedback method in the treatment of dysphonia (literature review)]. / Primenenie metoda biologicheskoi obratnoi svyazi pri lechenii disfonii (obzor literatury).

The literature review describes the experience of using the biofeedback method in the treatment of dysphonia of various etiologies. Indications for the use of this method and its effectiveness in a certain contingent of patients are discussed.

[Evaluation of the results of treatment of patients with functional dysphonia using a cepstral test]. / Otsenka rezul'tatov lecheniya patsientov s funktsional'noi disfoniei s pomoshch'yu kepstral'nogo testa.

In order to evaluate the effectiveness of the treatment in patients with functional dysphonia, the Cepstral Peak Prominence (CPP) test was used. Twenty dysphonic women aged from 18 to 47 years were under observation. The control group consisted of 20 healthy women of close age. Patients underwent 5-7 sessions electrostimulation of laryngeal muscles and phonopedic treatment, after which a complete restoration of the voice was noted. The Praat clinical program was used, installed on a Hewlett-Packard 630 laptop (Pentium B960, 2.2 GHz). A SHURE SM94 condenser microphone was used as well. In the control group, the results were as follows: M=7.49 (SD=1.26) dB. In the main group before treatment: M=5.00 (SD=1.07) dB, after treatment: M=7.95 (SD=1.34) dB. Differences in KT values in the main group before and after treatment (5.00 dB and 7.95 dB, respectively) were significant at p<0.0001. Differences in KT values in the main group before treatment (5.00 dB) and in the control group (7.49 dB) were significant at p<0.0001. Differences in KT values in the main group after treatment (7.95 dB) and in the control group (7.49 dB) were not significant at p>0.05. The study showed high sensitivity of the method. The CPP data after treatment were higher than those before treatment and did not differ from the control ones. It is concluded that CPP is a highly sensitive method for evaluating the degree of periodicity of an acoustic signal and can be used to evaluate the effectiveness of treatment in patients with functional dysphonia.

Effects of Transcutaneous Electrical Nervous Stimulation (TENS) on Dysphonic Patients: A Systematic Review Study.

Background and Objectives: Transcutaneous electrical nerve stimulation (TENS), a pain-alleviating and muscle-relaxing treatment used in physio-therapeutic clinical practice, has recently appeared to be just as effective in dysphonia. This review aimed at clarifying whether TENS can be an effective practice in dysphonia therapy and/or management on its own or combined with other types of interventions and, hence, whether its practice can be a useful, more widespread establishment to speech and language therapy intervention methods. Materials and Methods: A search was conducted on the PubMed database using specific terms based on the PICO search strategy. Eventually, four randomized controlled studies and four clinical trials were included. The methodological quality of the included studies was evaluated using the physiotherapy evidence-based database (PEDro) assessment tool, and this indicated high-quality research with an average score of 8.43. Results: The studies utilized various TENS devices, predominantly the Dualpex 961 device (frequency of 10 Hz, phase of 200 ms). The assessment methods varied, including auditory perception, vocal therapy, electrostimulation, audio and video perceptual assessments, and laryngeal evaluations. The clinical outcomes of TENS showed a reduction in musculoskeletal pain in various areas, while the acoustic analysis results were significant in only one study. TENS was compared to manual laryngeal therapy (LMT), placebo TENS, and vocal therapy in different studies with mixed results. Conclusions: This review supports the idea that a multidimensional approach, incorporating various therapeutic modalities (TENS, LMT, speech therapy, and vocal training) can yield positive outcomes for patients with voice disorders. Further research is needed to explore the specific mechanisms of action and optimal treatment protocols for TENS in voice therapy.

Hoarseness: When to observe and when to refer.

The terms hoarseness and dysphonia are used interchangeably, and both describe a type of altered vocal quality affecting one-third of patients. While hoarseness may be secondary to benign conditions such as reflux or viral laryngitis, it may suggest benign or malignant vocal-fold pathology. It is important for caregivers to know how to evaluate, treat, and when to refer patients for direct visualization via laryngoscopy. In this article, we review basic laryngeal anatomy and function, symptoms of vocal-fold pathology, and current guidelines from the American Academy of Otolaryngology-Head and Neck Surgery on the diagnosis and treatment of dysphonia, including patient referral.

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.

Examining Therapy Duration in Adults With Voice Disorders.

PURPOSE: This study examined the number of voice therapy sessions and the number of weeks in treatment to achieve desired voice outcomes in adults with voice disorders. Factors that may predict therapy duration were examined, as was the percentage of patients returning to the clinic for additional voice therapy after initial discharge. METHOD: An observational cohort design was utilized. Data from 558 patients were extracted from the University of Wisconsin-Madison Voice and Swallow Outcomes Database. Patients diagnosed with muscle tension dysphonia, vocal fold paralysis, benign vocal fold lesions, laryngospasm/irritable larynx, and presbyphonia were examined. Patient demographics, auditory-perceptual assessments, acoustics, aerodynamics, videostroboscopy ratings, self-reported scales, and medical comorbidities were collected. RESULTS: Patients required an average of 5.32 (SD = 3.43) sessions of voice therapy before voice outcomes were sufficiently improved for discharge. Average number of sessions ranged from 4.3 for presbyphonia to 6.7 for benign vocal fold lesions. Baseline overall Grade Roughness Breathiness Asthenia and Strain rating (p < .001), Dysphonia Severity Index (p < .001), Voice Handicap Index score (p < .01), age (p = .006), and occupational voice user status (p < .001) significantly predicted the number of therapy sessions required. Overall, 14.5% of patients returned for additional voice therapy following an initial discharge from treatment. CONCLUSIONS: Findings inform our understanding of how many sessions patients with voice disorders require to achieve desired voice outcomes. Additional research is needed to optimize the efficacy of voice treatment and determine how recurrence of dysphonia might best be prevented.

Laryngeal dystonia.

Laryngeal dystonia (LD) is a rare neurological disorder emerging in middle-aged persons as a chronic and disabling voice disorder. It is a focal dystonia affecting intrinsic laryngeal muscle control only during speech, resulting in voice breaks, effortful phonation, and strangled voice. Due to lack of awareness and lack of well-defined diagnostic criteria, it can be difficult for patients to be diagnosed and treated. This review, the first Danish publication on the subject of LD, presents the latest terminology, a brief history, treatment options and the psychosocial consequences of LD.

Elaboração de um guia sobre saúde vocal infantil / Elaboration of a guide on children's vocal health / Elaboración de una guía sobre salud vocal infantil

Introdução: Materiais educativos sobre cuidados com a voz dão apoio no atendimento clínico e prevenção de disfonia, entretanto, são escassos. Portanto, este estudo objetivou elaborar e avaliar um guia sobre saúde vocal infantil para pais e crianças. Descrição: A elaboração do guia abrangeu: Levantamento Bibliográfico nas bases de dados Biblioteca Virtual em Saúde (BVS) e Público/editora MEDLINE (PubMed); Escrita dos temas; Organização/escrita dos conteúdos/referências; Seleção de imagens. Estruturação do guia: Produção da voz; Sinais/sintomas mais comuns de alterações vocais; Causas dos distúrbios vocais infantis; Consequências do distúrbio vocal infantil; Profissionais envolvidos no diagnóstico e tratamento; Mito e Verdade sobre voz; Como prevenir o distúrbio vocal infantil; Atividades amigas da voz. A avaliação foi em grupo focal, via Google Meet, com três juízes mestrandos em Fonoaudiologia, que discutiram qualitativamente estética, conteúdo e organização. A discussão foi coordenada pela coorientadora e as indicações, realizadas por consenso entre os juízes: Estética - ajustar local das referências, elaborar jogo de trilha, uniformizar desenhos/cores e criar mascote; Conteúdo - material relevante, diminuir textos, adequar a linguagem para crianças, usar links/QR-Code para informações extras e acrescentar orientações para professores; Organização - tópicos em ordem hierárquica, conteúdo relacionado ao tema e separar assuntos por capítulos. Considerações Finais: Foram apontadas mudanças, porém, os juízes ressaltaram a importância deste material na clínica fonoaudiológica e na promoção de saúde vocal. O grupo focal foi importante para a primeira avaliação do guia. (AU)

Introduction: Educational materials on voice care support in clinical care and dysphonia prevention, however, are scarce. Therefore, this study aimed to elaborate and evaluate a guide on child vocal health for parents and children. Description: The elaboration of the guide covered: Bibliographic Survey in the databases Biblioteca Virtual em Saúde (BVS) and MEDLINE Public/Publisher (Pubmed); Themes writing; Organization/writing of the contents/references; Selection of images. Structure of the guide: Voice production; Most common signs/symptoms of vocal disorders; Causes of voice disorders in childhood; Consequences of voice disorders in childhood; Professionals involved in diagnosis and treatment; Myth and Truth about voice; How to prevent vocal disorder in childhood; Voice-friendly activities. The evaluation was in a focus group, via Google Meet, with three Master Judges in Speech Therapy, who discussed qualitatively aesthetics, content and organization. The discussion was coordinated by the co-supervisor and the following recommendations were consensus among the judges: Aesthetics - adjust location of references, elaborate track game, standardize drawings/colors and, create mascot; Content -relevant material, decrease texts, tailor language for children, use/QR-Code links for extra information and, add guidance for teachers; Organization - topics in hierarchical order, content according to theme and separate subjects by chapters. Final Considerations: Improvements were pointed out, however, the judges emphasized the importance of this material in the speech therapy clinic and vocal health promotion. The focus group was important for the guide's first evaluation. (AU)

Introducción: Los materiales educativos sobre cuidados con la voz dan apoyo en la atención clínica y prevención de la disfonía, sin embargo, son escasos. Por lo tanto, este estudio tuvo como objetivo elaborar y evaluar una guía sobre salud vocal infantil para padres e hijos. Descripción: La elaboración de la guía abarcó: Levantamiento Bibliográfico en las bases de datos Biblioteca Virtual en Salud (BVS)/MEDLINE Público/Editor (PubMed); Escritura de los temas; Organización/escritura de los contenidos/referencias; Selección de imágenes. Estructuración de la guía: Producción de la voz; Signos/síntomas más comunes de alteraciones vocales; Causas de los trastornos vocales infantiles; Consecuencias del trastorno vocal infantil; Profesionales involucrados en el diagnóstico y tratamiento; Mito y Verdad sobre voz; Cómo prevenir el trastorno vocal infantil; Actividades amigas de la voz. La evaluación fue en grupo focal, vía Google Meet, con tres jueces maestres en Fonoaudiología, que discutieron cualitativamente estética, contenido y organización. La discusión fue conducida por la coordinadora y las indicaciones, realizadas por consenso entre los jueces: Estética - ajustar lugar de las referencias, elaborar juego de pista, uniformizar dibujos/colores y crear mascota; Contenido - material relevante, disminuir textos, adecuar el lenguaje para niños, usar links/QR-Code para informaciones extras y añadir orientaciones para profesores; Organización - tópicos en orden jerárquico, contenido relacionado al tema y separar asuntos por capítulos. Consideraciones Finales: Se señalaron cambios, sin embargo, los jueces resaltaron la importancia de este material en la clínica fonoaudiológica y en la promoción de salud vocal. El grupo focal fue importante para la primera evaluación de la guía. (AU)

Blue light laser recontouring for pediatric benign fibrovascular vocal fold lesions.

INTRODUCTION: Up to 40% of children with hoarseness due to benign fibrovascular vocal fold lesions do not respond to voice therapy and could benefit from further intervention to improve their communication abilities. Currently there are limited surgical options for children too young to comply with post-operative voice rest. We have begun using the 445 nm laser to recontour benign fibrovascular vocal fold lesions without post-operative voice rest in young children with hoarseness due to vocal fold nodules that is unresponsive to voice therapy. This report presents pilot data on the effect of this treatment on pediatric voice-related quality of life. METHODS: Pediatric patients with benign fibrovascular lesions and severe subjective dysphonia (per parents or teachers) were given the option of undergoing surgery or continuing voice therapy. Those that opted for surgery underwent 445 nm laser recontouring of their vocal folds. They were discharged home the same day with no voice rest required. Pre- and post-demographic, acoustic measures, auditory perceptual assessments, and validated patient quality of life measures were collected. RESULTS: Four patients (ages 3-8y, all male) were selected for surgery. The mean pre- and post-op PVRQOL scores were 59.4 (range: 22.5-80) and 98.1 (range: 97.5-100), respectively (low scores suggest lower voice-related QOL), and a mean change of 38.8 (previously established minimum clinically important difference: 12). Pre- and post-acoustic and aerodynamic measures similarly reflected this improvement. CONCLUSION: This pilot case series addresses a commonly seen population (children with benign fibrovascular lesions and significant dysphonia despite voice therapy) where the best practice for timing and types of surgical intervention is unclear. Photoangiolytic lasers (including the 445 nm laser) are gaining popularity for the treatment of benign laryngeal pathologies, and their use may expand treatment possibilities for children with severe dysphonia due to benign vocal fold lesions that do not respond to voice therapy. Further longitudinal investigations are necessary to confirm the safety and efficacy.

The effects of transcutaneous electrical nerve stimulation on muscle activity pattern in professional voice users with muscle tension dysphonia using surface electromyography data: A pilot study.

OBJECTIVES: Muscle Tension Dysphonia is a voice disorder, which results in stiffness in the laryngeal extrinsic muscles, intense collision, painful contractions, and vibrations of the vocal cords. Due to the multifactorial identity of Muscle Tension Dysphonia, its therapeutic approach must be multidisciplinary. METHODS: The participants were divided into two groups: a control group (5participants) that received Circumlaryngeal Manual Therapy (CMT) + Placebo Transcutaneous Electrical Nerve Stimulation and an experimental group (5participants) that received Transcutaneous Electrical Nerve Stimulation + CMT. Both groups received 10 sessions of treatment, twice a week, for 40 min each. Before and after treatment, participants were assessed using the Dysphonia Severity Index (DSI) and surface electromyography for their ability to sustain the vowels /e& u/and count from 20 to30. RESULT: After therapy, there were substantial improvements in the DSI (2.72 ± 0.55, P < 0.05) and muscle electrical activity in the control group. The DSI (3.66 ± 0.63, P < 0.05) and muscle electrical activity were also significantly improved in the experimental group after treatment. The findings of the between-group comparison after treatment revealed a significantly greater increase in the Dysphonia Severity Index in the experimental group compared with the control group (P = 0.037). Although there was no significant difference between the two groups in terms of muscle electrical activity, clinically significant changes were more noticeable in the experimental group when compared with the control group. CONCLUSIONS: Positive results were seen in both groups. The results demonstrate that both approaches relax vocal tract muscles. As a result, Transcutaneous Electrical Nerve Stimulation was recommended as a complementary treatment for clients with Muscle Tension Dysphonia.

Immediate effects of a semi-occluded water-resistance ventilation mask on vocal outcomes in women with dysphonia.

INTRODUCTION: Semi-occluded vocal tract exercises (SOVTEs) are frequently used exercises in voice therapy. An important shortcoming to most SOVTEs is the inability to include continuous speech in these exercises. A variation of water-resistance therapy (WRT), during which a patient phonates through a resonance tube ending in water, was developed to include continuous speech: the semi-occluded water resistance ventilation mask (SOVM-WR). The current study investigated the immediate effects of this innovative technique on vocal outcomes of women with dysphonia. METHODS: A pretest-posttest randomized controlled trial was performed. Twenty female participants were randomly assigned to the experimental SOVM-WR group or the WRT (control) group. A blinded multidimensional voice assessment was conducted before and after a 30-minute therapy session with the assigned technique. RESULTS: No significant changes were found in acoustic or auditory-perceptual vocal outcomes in either of the groups, except for a significant increase in lowest frequency in both groups. Patient-reported outcomes (PROMs) showed significant improvements of vocal comfort, vocal effort, and voice quality in both groups, and participants indicated that they would use the techniques at home. CONCLUSIONS: The similar results of the SOVM-WR to WRT and promising PROMs confirm its suitability as an alternative to the latter technique. Potential reasons for a lack of improvement of objective and auditory-perceptual vocal outcomes are vocal fatigue, tube dimensions and immersion, and the small sample size. Large-scale and longitudinal research is needed to examine whether the SOVM-WR has a higher transfer to spontaneous speech than WRT after a full therapy program.

Indexing Cognitive Resource Usage for Acquisition of Initial Voice Therapy Targets.

PURPOSE: The purpose of this study was to index cognitive resource usage for acquisition of initial targets of two common voice therapy techniques (resonant voice therapy [RVT] and conversation training therapy [CTT]) based on the theorized depletion effect (i.e., when an initial task requiring high cognitive load leads to poorer performance on a subsequent task). METHOD: Eleven vocally healthy participants, ages 23-41 years, read aloud the Rainbow Passage and produced consonant-vowel resonant targets (/mi, ma, mu/) followed by a baseline computerized Stroop task and a 15-min washout. Following this baseline period, participants watched and interacted with two videos instructing them in RVT or CTT initial targets. After viewing each video and practicing the associated vocal skills, participants rated the degree of mental effort required to engage in the target vocal technique on a modified Borg scale. Participants recorded their attempts at RVT on /mi, ma, mu/ and CTT on the Rainbow Passage, which were later rated by three voice-specialized speech-language pathologists as to how representative they were of each respective target technique. Changes in fundamental frequency and average auditory-perceptual ratings from baseline were examined to determine if participants adjusted their technique from RVT and CTT baseline to acquisition. RESULTS: Performance on the Stroop task was, on average, worse post CTT than post RVT, but both post-CTT and post-RVT Stroop scores were poorer than baseline. These results suggest that both treatment techniques taxed cognitive resources but that CTT was more cognitively taxing than RVT. However, despite differences in raw averages, no statistically significant differences were found between the baseline, post-CTT, and post-RVT Stroop scores, likely due to the small sample size. Participant ratings of mental effort for CTT and RVT were statistically similar. Likewise, poorer post-RVT Stroop scores were associated with participants' greater perceived mental effort with RVT acquisition, but there was no significant association between mental effort ratings for CTT acquisition and post-CTT Stroop scores. Significantly higher fundamental frequency and perceived ratings of the accuracy of technique from baseline to acquisition for both CTT and RVT were found, providing evidence of vocal behavior changes as a result of each technique. CONCLUSIONS: Brief exposure to initial treatment tasks in CTT is more cognitively depleting than initial RVT tasks. Results also indicate that vocally healthy participants are able to make a voice change in response to a brief therapy prompt. Finally, participant-rated measures of mental effort and secondary measures of cognitive depletion do not always correlate.