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Role of early voice therapy in patients affected by unilateral vocal fold paralysis

Published online by Cambridge University Press:  24 October 2007

L D'Alatri ,
S Galla ,
M Rigante ,
O Antonelli ,
S Buldrini  and
M R Marchese
L D'Alatri*
Affiliation:
Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy
S Galla
Affiliation:
Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy
M Rigante
Affiliation:
Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy
O Antonelli
Affiliation:
Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy
S Buldrini
Affiliation:
Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy
M R Marchese
Affiliation:
Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy
*
Address for correspondence: Dr Lucia D'Alatri, Policilinico Universitario ‘A Gemelli’, Università Cattolica del Sacro Cuore, Largo Gemelli n 8, 00168 Rome, Italy. Fax: +39 6 3051194 E-mail: [email protected]
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Abstract

Objective:

To evaluate the functional results obtained after voice therapy in patients with unilateral vocal fold paralysis caused by different aetiologies.

Design:

Prospective analysis of the outcome of unilateral vocal fold paralysis cases treated at our speech and language rehabilitation service from November 2003 to January 2006. Thirty cases underwent behavioural treatment, between two and six weeks after unilateral vocal fold paralysis onset. A multi-dimensional assessment was carried out before, immediately after and six months after treatment.

Results:

After behavioural therapy, the prevalence of complete glottal closure increased significantly (p < 0.05). Subjects' pre-therapy mean values for jitter, shimmer and noise-to-harmonic ratio were statistically significantly different from those taken both immediately and six months after treatment (p < 0.05). The mean values for voice turbulence index significantly improved only six months after therapy (0.08 vs 0.04). At both post-treatment assessments, voice range profile analysis showed a significant decrease of lowest voice frequency and a significant increase of the number of semitones (p < 0.05). Mean values for grade, instability, breathiness, asthenia and voice handicap index scores were significantly decreased both immediately and six months after treatment, compared with pre-treatment values (p < 0.05).

Conclusions:

Early voice therapy may enable significant improvement in vocal function, allowing the patient to avoid surgery.

Keywords

Vocal Cord ParalysisVoice DisordersRecurrent Laryngeal NerveSpeech Therapy
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 122 , Issue 9 , September 2008 , pp. 936 - 941
Copyright
Copyright © JLO (1984) Limited 2007

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References

1 Miller, S. Voice therapy for vocal fold paralysis. Otolaryngol Clin North Am 2004;37:105–19CrossRefGoogle ScholarPubMed
2 Stemple, JC, Glaze, LE, Klaben, BG. Clinical Voice Pathology: Theory and Management, 3rd edn. San Diego: Singular Publishing; 2000;142–66Google Scholar
3 McFarlane, S, Watterson, T, Lewis, K, Boone, D. Effect of voice therapy facilitation techniques on airflow in unilateral paralysis patients. Phonoscope 1998;1:187–91Google Scholar
4 Boone, DR, McFarlane, SC. The Voice and Voice Therapy, 4th edn. Englewood Cliffs, New Jersey: Prentice-Hall, 1988Google Scholar
5 Stemple, JC, Lee, L, D'Amico, B, Pickup, B. Efficacy of vocal function exercises as a method of improving voice production. J Voice 1994;8:271–7CrossRefGoogle ScholarPubMed
6 Verdolini, K, Druker, DG, Palmer, PM, Samawi, H. Laryngeal adduction in resonant voice. J Voice 1998;12:315–27CrossRefGoogle ScholarPubMed
7 Kotby, MN, Shiromoto, O, Hirano, M. The accent method of voice therapy: effect of accentuations on F0, SPL and airflow. J Voice 1993;7:319–25CrossRefGoogle Scholar
8 McGowan, RS. Tongue-tip trills and vocal-tract wall compliance. J Acoust Soc Am 1992;91:2903–10CrossRefGoogle ScholarPubMed
9 Colton, RH, Casper, JK. Understanding voice problems: a physiological perspective for the diagnosis and treatment. Philadelphia: Lippincott Williams & Wilkins, 1996;358–60Google Scholar
10 Heuer, RJ, Sataloff, RT, Emerich, K, Rulnick, R, Baroody, M, Spiegel, JR et al. Unilateral recurrent laryngeal nerve paralysis: the importance of “preoperative” voice therapy. J Voice 1997;11:88–94CrossRefGoogle ScholarPubMed
11 Behrman, A. Evidence-based treatment of paralytic dysphonia: making sense of outcomes and efficacy data. Otolaryngol Clin North Am 2004;37:75–104CrossRefGoogle ScholarPubMed
12 Williams, RT, Farquharson, IM, Anthony, J. Fiberoptic laryngoscopy in the assessment of laryngeal disorder. J Laryngol Otol 1975;89:299–306CrossRefGoogle Scholar
13 Colton, RH, Estill, J. Elements of voice quality, perceptual acoustic and physiologic aspects. In: Lass, N, ed. Speech and language: advances in basic research and practice. New York: Academic Press, 1981;311–403Google Scholar
14 Aaronson, A. Clinical Voice Disorders, 3rd edn. New York: Thieme Stratton, 1980Google Scholar
15 Roy, N, Bless, DM, Helsey, D, Ford, CN. Manual circumlaryngeal therapy for functional dysphonia: an evaluation of short- and long-term treatment outcomes. J Voice 1997;11:321–31CrossRefGoogle Scholar
16 http//www.ncvs.org/ncvs/library/pubs/sumstat/sumstat.pdf [10 February 2007]Google Scholar
17 Hirano, M. Psycho-acoustic evaluation of voice. In: Hirano, M, ed. Clinical Examination of Voice. New York: Springer-Verlag, 1981;81–4Google Scholar
18 Dejonckere, P, Remacle, M, Fresnel-Elbaz, E, Woisard, V, Crevier-Buchman, L, Millet, B. Differentiated perceptual evaluation of pathological voice quality: reliability and correlations with acoustic measurements. Rev Laryngol Otol Rhinol (Bord) 1996;3:219–24Google Scholar
19 Jacobson, BH, Johnson, A, Grywalski, A, Silbergeit, A, Jacobson, G, Benninger, MS et al. The Voice Handicap Index (VHI): development and validation. Am J Speech Lang Pathol 1997;6:66–70CrossRefGoogle Scholar
20 Dejonckere, PH, Bradley, P, Clemente, P, Cornut, G, Crevier-Buchman, L, Friedrich, G et al. A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques. Eur Arch Otorhinolaryngol 2001;258:77–82CrossRefGoogle ScholarPubMed
21 Hirano, M, Bless, D. Videostroboscopic Evaluation of the Larynx. San Diego: Singular Press, 1987;43Google Scholar
22 Morsomme, D, Jamart, J, Wery, C, Giovanni, A, Remacle, M. Comparison between the GIRBAS scale and the acoustic and aerodynamic measures provided by EVA for the assessment of dysphonia following unilateral vocal fold paralysis. Folia Phoniatr Logop 2001;53:317–25CrossRefGoogle ScholarPubMed
23 Benninger, MS, Ahuja, AS, Gardner, G, Grywalski, C. Assessing outcomes for dysphonic patients. J Voice 1998;12:540–50CrossRefGoogle ScholarPubMed
24 Rosen, CA, Murry, T, Zinn, A, Zullo, T, Sonbolian, M. Voice handicap index change following treatment of voice disorders. J Voice 2000;14:619–23CrossRefGoogle ScholarPubMed
25 Koufman, JA, Postma, GN, Cummins, MM, Blalock, PD. Vocal fold paresis. Otolaryngol Head Neck Surg 2000;122:537–41Google ScholarPubMed
26 Flint, PW, Purcell, LL, Cummings, CW. Pathophysiology and indications for medialization thyroplasty in patients with dysphagia and aspiration. Otolaryngol Head Neck Surg 1997;116:349–54CrossRefGoogle ScholarPubMed
27 Crumley, RL. Laryngeal reinnervation techniques. In: Ford, C, Bless, D, eds. Phonosurgery. New York: Raven, 1991;201–12Google Scholar
28 Tashiro, T. Experimental studies of the reinnervation of the larynx after accurate neurorrhaphy. Laryngoscope 1972;82:225–36CrossRefGoogle ScholarPubMed
29 Crumley, RL. Laryngeal synkinesis: its significance to the laryngologist. Ann Otol Rhinol Laryngol 1989;98:87–92CrossRefGoogle Scholar
30 Flint, PW, Downs, DH, Coltrera, MD. Laryngeal synkinesis following reinnervation in the rat. Neuroanatomic and physiologic study using retrograde fluorescent tracers and electromyography. Ann Otol Rhinol Laryngol 1991;100:797–806CrossRefGoogle ScholarPubMed