Timing of Voice Therapy: A Primary Investigation of Voice Outcomes for Surgical Benign Vocal Fold Lesion Patients

Tang, Sharon; Thibeault, Susan L.

doi:10.1016/j.jvoice.2015.12.005

Cited by 30 publications

(20 citation statements)

References 28 publications

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“…The lack of general consensus is made evident by a survey of members of the American Academy of Otolaryngology–Head and Neck Surgery, which demonstrated that 91% of respondents use VT as first‐line treatment for nodules, but were divided regarding the use of VT as initial treatment for polyps and cysts, constituting 30% and 22%, respectively . Several studies support the utility of VT as the mainstay treatment of patients with VF polyps, whereas others note phonosurgery to be the preferred treatment strategy . These previous studies have been limited by small sample sizes, lack of validated outcome measures, or lack of statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Comparing short‐term outcomes of surgery and voice therapy for patients with vocal fold polyps

et al. 2019

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Objectives/Hypothesis Optimal treatment for patients with vocal fold polyps (VFPs) remains controversial. We compared the short‐term outcomes of treatment with voice therapy alone (VT), surgery alone (SUR)m or voice therapy and surgery (VTS). Study Design Retrospective case series. Methods A retrospective study was performed for patients diagnosed with VFP (International Classification of Diseases, Ninth Revision code 478.4 and Tenth Revision code J38.1) between January 2010 and April 2016. Inclusion criteria were age greater than 18 years and charted evidence of treatment with voice therapy, surgery, or both. Exclusion criteria were history of laryngeal cancer or radiation above the clavicles. Outcomes measured included chart records of lesion absence, persistence or recurrence, and differences between pretreatment and post‐treatment Voice Handicap Index‐10 and GRBAS (G/grade, R/roughness, B/breathiness, A/asthenia, S/strain) scores. Results One hundred twenty patients with VFPs were identified (SUR = 23, 19.2%, VT = 29, 24.2%, VTS = 68, 56.7%). Mean follow‐up was 5.5 months. There were no recurrences in 115 patients (95.8%). There was significant improvement from pre‐ to post‐treatment VHI‐10 scores in the SUR (mean improvement = 12.5, standard deviation [SD] = 12.7) and VTS (mean improvement = 12.3, SD = 10.3) groups compared to the VT (mean improvement = 2.84, SD = 11.9) group (P = .009). Pre‐ and post‐treatment GRBAS scores did not significantly change in any group. Conclusions When using patient‐reported outcomes measures, patients with VFPs receive the greatest short‐term gains from treatment paradigms involving surgery or a combination of surgery and voice therapy. Voice therapy alone did not result in significant short‐term changes. Perceptual voice characteristics did not change significantly for any group. Further research on long‐term treatment outcomes for patients with VFPs is needed. Level of Evidence 3 Laryngoscope, 129:1067–1070, 2019

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Section: Discussionmentioning

confidence: 99%

Comparing short‐term outcomes of surgery and voice therapy for patients with vocal fold polyps

et al. 2019

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“…However, in the majority of lesions, it acts primarily as an adjunctive therapy to a surgical intervention [7,8]. In these cases, it is still not clear when it is best to begin with voice therapy, though Tang et al showed that even a presurgical application has positive effects on subjective voice parameters [9].…”

Section: Vocal Restmentioning

confidence: 99%

In vitro mechanical vibration down-regulates pro-inflammatory and pro-fibrotic signaling in human vocal fold fibroblasts

et al. 2020

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Introduction Voice rest following phonotrauma or phonosurgery has a considerable clinical impact, but clinical recommendations are inconsistent due to inconclusive data. As biopsies of the vocal folds (VF) for molecular biology studies in humans are unethical, we established a new in vitro model to explore the effects of vibration on human vocal fold fibroblasts (hVFF) in an inflammatory and normal state, which is based on previously published models. Methods By using a phonomimetic bioreactor we were able to apply predefined vibrational stress patterns on hVFF cultured under inflammatory or normal conditions. Inflammatory and pro-fibrotic stimuli were induced by interleukin (IL)1β and transforming growth factor (TGF)β1, respectively. Mechanical stimulation was applied four hours daily, over a period of 72 hours. Outcome measurements comprised assessment of extracellular matrix (ECM)-related components, angiogenic factors, and inflammatory and fibrogenic markers on gene expression and protein levels. Results Under inflammatory conditions, the inflammatory cytokine IL11, as well as the myofibroblast marker alpha smooth muscle actin (α-SMA) were significantly reduced when additional vibration was applied. The desirable anti-fibrotic ECM component hyaluronic acid was increased following cytokine treatment, but was not diminished following vibration. Conclusion Our experiments revealed the effect of vibrational stress on hVFF in an inflammatory state. Elevated levels of certain pro-inflammatory/pro-fibrotic factors could be mitigated by additional vibrational excitation in an in vitro setting. These findings corroborate clinical studies which recommend early voice activation following an acute event.

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“…38 In addition, even though surgical intervention is necessary, individuals undergoing speech therapy prior to laryngeal surgery showed subjective improvement in relation to their self-perception of vocal quality and function. 41,39 On the other hand, the combination of speech therapy and surgery is considered responsible for obtaining better results for the vocal quality of the patient, and postsurgical therapy is important in helping to improve glottic coaptation and vocal fold mucosa vibration. 9,37 It is also important to point out that the presence of an interdisciplinary team to diagnosis and define the best intervention may have been one of the factors that influenced the considerable percentage of individuals who underwent speech therapy, since the interdisciplinary discussion of the case at the time of examination facilitated this referral.…”

Section: Discussionmentioning

confidence: 99%

Minor Structural Alterations of the Vocal Fold Cover: Vocal Quality before and after Treatment

Brito

Silva

Moraes

et al. 2020

Int Arch Otorhinolaryngol

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Introduction Minor structural alterations of the vocal fold cover are important causes of dysphonia. The variability in the type of alteration and the grade of vocal deviation affects the definition of the conduit and the results of treatment. Objective To characterize the occurrence, the selected treatments adopted and vocal quality before and after treatment in patients with minor structural alterations of the vocal folds cover. Methods This was a cross-sectional study based on the records of patients treated by an interdisciplinary team at the laryngology outpatient clinic of a public university hospital from 2010 to 2018. Data collection consisted of access to a database of information on otorhinolaryngological diagnostic hypotheses, intervention and perceptual-auditory vocal assessments before and after the treatment. Data from 102 subjects were analyzed. Association tests were applied between the perceptual-auditory vocal results and the different alterations found and between these and the adopted treatments. The results of the degrees of vocal deviation before and after treatment were also compared. Results The degree of roughness was associated with the sulcus vocalis, and in this alteration the highest occurrence was mild degree of roughness. There was an improvement in the breathiness and general grade of vocal deviation after treatment. Conclusion Cysts were the most frequent structural alteration in the population studied. There was an association between the degree of general deviation and that of roughness in sulcus vocalis cases. The breathiness and the general grade of vocal deviation improved after treatment regardless of the type of treatment and alteration.

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Timing of Voice Therapy: A Primary Investigation of Voice Outcomes for Surgical Benign Vocal Fold Lesion Patients

Cited by 30 publications

References 28 publications

Comparing short‐term outcomes of surgery and voice therapy for patients with vocal fold polyps

Comparing short‐term outcomes of surgery and voice therapy for patients with vocal fold polyps

In vitro mechanical vibration down-regulates pro-inflammatory and pro-fibrotic signaling in human vocal fold fibroblasts

Minor Structural Alterations of the Vocal Fold Cover: Vocal Quality before and after Treatment

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