This is the unspecified version of the paper.This version of the publication may differ from the final published version. Permanent repository link Abstract Objectives/HypothesesThe objectives of this study were to determine appropriate acoustic and outcome measures for the evaluation of a method of laryngeal manual therapy (LMT) used in the treatment of patients with muscle tension dysphonia (MTD). The effects of this technique was also investigated. The study was based on the hypotheses that the vertical position of the larynx in the vocal tract would lower, that the quality of the voice would normalize, and that a reduction in any vocal tract discomfort would occur following LMT. Study designThis was a small, prospective, repeated measures pilot study in which each member of the research team was 'blinded' to all other stages of the study and during which all data were anonymized until the final stage of data analysis. MethodsTen subjects presenting with MTD completed outcome measures and provided audiorecordings immediately before, immediately after and one week after LMT. The Kay CSL 4150 was used for acoustic and spectrographic measurements. A new perceptual, self-rating scale, the Vocal Tract Discomfort Scale, and a new proforma for use by the clinician for palpatory evaluation, were developed for the study. ResultsRelative average perturbation during connected speech was significantly reduced following LMT, indicating a reduction in abnormal vocal function. The severity and frequency of vocal tract discomfort was shown to have reduced following LMT. ConclusionsThis pilot study showed positive evidence for laryngeal manual therapy as a method of therapy in the treatment of hyperfunctional voice disorders. Its effects were shown to be measurable with both acoustical analysis and the Vocal Tract Discomfort scale.

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This document is a position statement on the formal perceptual evaluation of voice quality in the United Kingdom (UK). It addresses a number of clinical issues pertaining to the complexity of voice quality analysis. There is also a brief description of the three formal perceptual protocols most commonly used in the UK: The Vocal Profile Analysis (VPA), GRBAS and The Buffalo III Voice Profile. Potential clinical problems with perceptual voice quality evaluation are highlighted. Problems associated with the lack of defined terminology, limitless variety of voice quality, general lack of reliability data and difficulties in determining specificity and sensitivity are discussed. A practical guide for selecting an evaluation scheme is described. The conclusion is that the GRBAS scheme should be recommended as the absolute minimum standard for practising UK voice clinicians. However, there is a clear need to develop a more satisfactory perceptual rating scheme that is clinically realistic, theoretically sound, internationally acceptable and has proven reliability.

There is evidence that laryngeal manual therapy, in various forms, can be a useful primary intervention in cases of muscle tension dysphonia, although this is based on very few studies. A higher level of evidence is required, including randomized controlled trials, to investigate its role in comparison with other interventions. Studies are also needed to verify or refute the clinical observation that it is also an effective treatment for all voice disorders, including those of organic aetiology, when phonatory hyperfunction is a feature.

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