Delivery of Intensive Voice Therapy for Vocal Fold Nodules Via Telepractice: A Pilot Feasibility and Efficacy Study

Abstract

Analyses were performed by a speech-language pathologist and an otolaryngologist independent to and blinded to the study. Participants also completed the Voice Handicap Index and a telepractice satisfaction questionnaire, or an anticipated satisfaction questionnaire, before and after treatment.Results. Significant improvements were found in perceptual, vocal fold function, acoustic and physiological parameters as well nodule sizes and patient perceptions of voice-related quality of life post treatment. Participants were highly positive about their first experience with telerepractice. Results were similar to those from a separate study investigating the effects of an intensive voice therapy delivered in conventional face-to-face format.Conclusions. This study is consistent with possible benefits of telepractice in the delivery of intensive treatment for vocal fold nodules. Pending final verification with a face-to-face comparison group, telepractice could be recommended as an alternate treatment modality for patients with vocal fold nodules.

Ensaio clínico controlado e randomizado de terapia breve e intensiva com finger kazzo em professoras: estudo preliminar

“…As this research on FK technique in vocal therapy is unprecedented, there were not found, to the date, similar findings to compare the results. However, the positive results found in the acoustic analysis are according to two studies that performed a form of LSVT in subjects with vocal fold nodules and showed significant reduction of jitter and shimmer and increased f0 (21,23) , as well as reducing the NHR (23) . The first study was conducted with 53 women and their goal was to compare the LSVT (eight sessions in three weeks) to traditional therapy (eight sessions in eight weeks).…”

“…To be included, the subjects should: be a teacher of kindergarten, elementary, middle or top of public or private networks of a medium-sized city of state of inner; being female (3,4,24) ; be in the age group between nineteen and sixty years old (4,11,23) ; has any of the following laryngeal conditions diagnosed by medical ENT: Normal larynx; posterior glottal opening or medio-posterior glottal opening, anterior gaps (caused by secondary muscle fatigue hypertension), supraglottic hyperconstriction (all of these are classified as "non-structural laryngeal disease") vocal fold nodules, vocal fold polyps, cysts, vasculodysgenesis or even leukoplakia, edema, laryngitis, thickening, irregularities edges of the vocal folds, hyperemia (all those classified as "structural laryngeal disease"); present habits and/or suggestive vocal behavior of hyperfunction (7,10) , and hours worked per week at or above to 20 hours.…”

“…To ensure the homogeneity of the sample, the following exclusion criteria were established: be on license period, work in breakout rooms or administrative activities; history of neurological, endocrine, psychiatric, stomach or chronic respiratory (4,11,21,23) ; account of pregnancy, menstruation or the premenstrual (around five days before the start of menstruation), flu or any respiratory allergy in the days of assessments and reassessments (10,11) ; account of alcoholism and/or smoking (4,11) ; prior speech therapy report related to voice or singing lessons to avoid the participation of subjects with greater vocal conditioning (21,23) ; hearing impairment (10,11,21,23) ; stomatognathic system alterations that could interfere in the implementation of FK or voice assessment tasks (12) ; participation in less than 70% of therapy sessions (2) . To identify the presence of any of the criteria above mentioned an interview was conducted, during which it was investigated the history, the presence of complaints, vocal demands and habits and incorrect use of the voice.…”

“…There was no previous training of the judges, considering the period of ten years of experience and the consensuality sufficient to carry out the judgments The judges received guidance on how to proceed with the analysis, and should not do them at the end of the day or being tired, being able to hear the voices through headphones as many times as necessary, in a quiet place (26) . -Stroboscopic parameters of evaluation: The examination was performed by an ENT doctor (equipment Atmos Lenzkirch® -Germany, with optical Storz® 70 -Tuttlingen, Germany), during which the teachers sent the vowels /e/, /i/ and phonation reverse with the head positioned in slight anterior tilt and up (8,21,23) . Examinations were later edited and coded, randomized and written in a pen drive to be evaluated by ENT judges.…”

“…Convinced of the benefits of FK, associated with evidence that direct voice therapy is superior to indirect therapy (7,20) , once that the latter is only effective when applied in conjunction with the first (1,21) , the hypothesis is that FK performed intensively manages benefits over power measurements glottal of dysphonic teachers. Furthermore, the benefits of intensive processing of voice include: voice recovery in a short period of time, increased adherence of the subject, increased use of session time, decreasing the time between sessions and increased ability to transfer strategies learned to everyday life (10,21,22,23) . Thus, it highlights the unprecedented contribution of the ongoing investigation against the current scientific scenario.…”