Effect of voice therapy with or without transcutaneous electrical stimulation on recovery of injured macroscopically intact recurrent laryngeal nerve after thyroid surgery

Abstract

Purpose Electrical stimulation-supported therapy is an often used modality. However, it still belongs to experimental methods in the human larynx. Data are lacking with which to evaluate the real effect in recurrent laryngeal nerve injury. The aim of this study was to investigate whether transcutaneous electrical stimulation added to voice therapy has a beneficial effect compared to voice therapy alone on vocal fold movement recovery in the case of an injured macroscopically intact recurrent laryngeal nerve. Methods Adults with unilateral vocal fold paralysis after thyroidectomy, in which the recurrent laryngeal nerve was left macroscopically intact, were included in this case-control study performed in tertiary referral hospital between September 2006 and June 2018. Among 175 eligible participants, 158 were included. Compliance with 6 months follow-up was 94.3%. Interventions: medicament therapy and voice therapy (group 1) vs. medicament therapy and voice therapy and transcutaneous electrical stimulation (group 2). Main outcome: vocal fold movement. Results A total of 149 patients were included in the analysis (group 1, 89 patients; group 2, 60 patients). The groups were homogenous. In groups 1 and 2, 64% and 60% of vocal folds, respectively, were improved after 6 months (P = 0.617). No difference was found between patients who improved and patients who did not improve. Conclusions Adding transcutaneous electrical stimulation to voice therapy provided no beneficial effect on the recovery of vocal fold movement. Therefore, its indications should be re-evaluated; it is questionable whether stimulation should be routinely recommended.

Estructura de los objetivos terapéuticos en la intervención fonoaudiológica de usuarios con necesidades vocales: una revisión sistemática exploratoria

“…Por otra parte, se aprecia que en varios objetivos, en los que sí aparece la noción de usuario, no se le asigna un rol central (Formánek et al, 2020;Quinn & Swain, 2018;Ribeiro et al, 2018;Sielska-Badurek et al, 2017), sino que este se mantiene en una posición pasiva frente a una tarea que es llevada a cabo por el/la terapeuta.…”

“…Por otra parte, en el caso de lo expuesto por Formánek et al (2020) se indica que la finalidad es "corregir el cierre de la glotis". Sin embargo, este tipo de objetivos, que plantean fines de tipo fisiológico, deben ser medidos, lógicamente, de manera acorde a lo formulado.…”

Orientaciones filosóficas en la intervención fonoaudiológica de voz. El desafío actual de dar el alta

“…En el presente artículo se desarrollan las orientaciones filosóficas en la terapia vocal, exponiendo las diversas formas de abordar un paciente. Por ejemplo, para algunas patologías el trabajo puede constar de cinco a seis sesiones de rehabilitación durante dos meses aproximadamente y en otras hasta veinte sesiones durante seis meses [1]. Cada uno de esos resultados podrán tener variaciones según la forma en que se aborde al paciente, con base al conocimiento del terapeuta y su experiencia, además de otros factores del propio paciente.…”