Early Initiation of Voice Therapy After Microlaryngeal Surgery - A Randomized Control Study

OBJECTIVE

A prospective single blinded randomized control trial was conducted to study if early initiation of voice therapy after microlaryngeal produces a better voice outcome in patients with benign vocal fold lesions.

METHODS

In this Patients undergoing microlaryngeal surgery for benign vocal fold lesions were recruited for the study and underwent voice evaluation and videostroboscopy preoperatively. Participants were randomised into two groups depending on the duration of voice rest-A (2 days voice rest) and B (5 days voice rest). Following the period of voice rest, voice therapy (tube phonation) was carried out for a month. Postoperative evaluation was done at 6 weeks (over telephone) and 3 months (in person visit) follow up. Outcome measures included the VHI-10, auditory-perceptual voice ratings, acoustic analysis and videostroboscopic vibratory ratings.

RESULTS

Of the 50 subjects, 35 completed the follow up evaluation. The overall compliance to absolute voice rest was 43%. Among the various parameters used for voice evaluation, there was no statistically significant difference between the two groups except for jitter, where the improvement in 5 day voice rest group compared to the 2 day voice rest group was statistically significant.

CONCLUSION

Prolonged voice rest after microlaryngeal surgery is difficult to comply with. As there was no significant difference between the two study groups, clinicians may prescribe a shorter duration of voice rest followed by early initiation of voice therapy after microlaryngeal surgery.

Examining Therapy Duration in Adults With Voice Disorders

PURPOSE

This study examined the number of voice therapy sessions and the number of weeks in treatment to achieve desired voice outcomes in adults with voice disorders. Factors that may predict therapy duration were examined, as was the percentage of patients returning to the clinic for additional voice therapy after initial discharge.

METHOD

An observational cohort design was utilized. Data from 558 patients were extracted from the University of Wisconsin-Madison Voice and Swallow Outcomes Database. Patients diagnosed with muscle tension dysphonia, vocal fold paralysis, benign vocal fold lesions, laryngospasm/irritable larynx, and presbyphonia were examined. Patient demographics, auditory-perceptual assessments, acoustics, aerodynamics, videostroboscopy ratings, self-reported scales, and medical comorbidities were collected.

RESULTS

Patients required an average of 5.32 (SD = 3.43) sessions of voice therapy before voice outcomes were sufficiently improved for discharge. Average number of sessions ranged from 4.3 for presbyphonia to 6.7 for benign vocal fold lesions. Baseline overall Grade Roughness Breathiness Asthenia and Strain rating (p < .001), Dysphonia Severity Index (p < .001), Voice Handicap Index score (p < .01), age (p = .006), and occupational voice user status (p < .001) significantly predicted the number of therapy sessions required. Overall, 14.5% of patients returned for additional voice therapy following an initial discharge from treatment.

CONCLUSIONS

Findings inform our understanding of how many sessions patients with voice disorders require to achieve desired voice outcomes. Additional research is needed to optimize the efficacy of voice treatment and determine how recurrence of dysphonia might best be prevented.

Treatment of relapsing functional and organic dysphonia: a narrative literature review

Information about failure and relapses is critical in deciding whether and how to treat a given condition, as well as during patient counselling before therapy. This paper aims to perform a non-systematic review of relapses and failure of dysphonia treatment in the adult population. Studies on failure and relapses after treatment of benign vocal fold lesions, functional dysphonia and neurogenic dysphonia were analysed. The frequency and the duration of follow-up were heterogeneous, and the management of relapses was reported in only a portion of the studies. Relapses after surgical treatment of benign vocal fold lesions ranged between 1% and 58% of cases, and their management was mainly surgical. Rates of relapse after voice therapy for functional dysphonia and spasmodic dysphonia were 12%-88% and 8%-63%, respectively. Rates of relapse after surgical treatment for unilateral and bilateral vocal fold paralysis were 10%-39% and 6%-25%, respectively; treatment was mainly represented by surgical revision. In conclusion, failure and relapses of functional and organic dysphonias after therapy are not rare, but treatment modalities are seldomly reported. The data from this non-systematic review stresses the need for further research in this area.

Voice outcomes following surgical treatment for pediatric vocal fold nodules: A systematic review and meta-analysis

OBJECTIVES

This study aimed to systematically review the literature to determine outcomes following surgical treatment of pediatric vocal fold nodules.

METHODS

Studies with patients ≤18 years with nodules who underwent surgery were reviewed for dysphonia improvement and recurrence in PubMed, EMBASE, Medline, CINAHL, Cochrane, Scopus, and Web of Science databases, searched from inception to November 1, 2022 using PRISMA guidelines. Non-English studies and case reports were excluded. Two evaluators independently reviewed each abstract and article. Heterogeneity and bias across studies were evaluated and meta-analysis was performed.

RESULTS

The literature search yielded 655 articles; 145 underwent full-text screening and eight were selected for systematic review and meta-analysis. There were 311 children with nodules, aged 2-18 years, with male-to-female ratio of 3.6:1. There were no surgical complications. Voice therapy was inconsistently reported. Follow-up time ranged from 1 month to 10 years. One study concluded that neither surgery nor voice therapy was effective, while five studies concluded that dysphonia improved with surgery. Voice grading by GRBAS, objective voice measures, and lesion size were improved following surgery, when reported. Meta-analysis of six studies demonstrated improvement in dysphonia in 90% of children post-operatively (95% CI: 74-99%). Meta-analysis of four studies showed that recurrence occurred in 19% of children (95% CI: 13-23%).

CONCLUSION

This systematic review suggests possible post-operative improvement in dysphonia for pediatric patients with vocal fold nodules; however, study measures, methods, and surgery utilized were heterogeneous and results should be interpreted cautiously. In order to better understand surgical outcomes, future studies should include standardized definition of nodules and objective measures of voice.

Systematic Review of Recurrence Rates of Benign Vocal Fold Lesions Following Surgery

OBJECTIVES

Benign vocal fold lesions which include vocal fold nodules, polyps, cysts and other lesions often recur after surgery and require additional treatments. This systematic review of the current literature evaluated the effects of adjunctive therapies in addition to surgical resection on the recurrence rates of benign vocal fold lesions in adults.

STUDY DESIGN

Systematic review.

METHODS

A search using relevant keywords in electronic databases was conducted. Extracted data include author, year of publication, patient demographics, diagnostic approach, lesion type, surgical procedure, type of adjunctive therapy and the rates of recurrence. Descriptive statistics were performed on the collected data when appropriate.

RESULTS

Eleven articles were identified with a total of 1085 patients. The total 1101 lesions studied included 591 (53.7%) polyps, 125 (11.4%) nodules, 146 (13.3%) cysts, 184 (16.7%) pseudocysts, 19 (1.7%) midfold masses, 18 (1.6%) sulcus vocalis and 18 (1.6%) varices. Besides surgery, adjunctive therapies included voice therapy, steroid injection and reflux medication. There were 141 reported lesion recurrences, with an average recurrence rate of 13.0%. The recurrence rate in studies with adjunctive therapies was 7.14%, and in studies with no adjunctive therapies it was 24.44%.

CONCLUSIONS

Available evidence suggests that adjunctive therapies following surgery are associated with decreased lesion recurrence rates. However, due to differences in sample size, inconsistent reporting of lesion characteristics, heterogeneity of adjunctive therapies, variability in follow-up time across studies, and other factors, it is not possible to determine exactly which adjunctive therapies are of significant benefit and which lesion types may benefit the most.

Efficacy of the Accent Method of Voice Therapy in Professional Voice Users with Minimal Associated Pathological Lesions of the Vocal Folds

Aims

Minimal associated pathological lesions (MAPLs) of the vocal folds are a group of benign disorders commonly related to phonotraumatic conditions and behaviors. Voice therapy (VT) can play a major role in readjusting these maladaptive behaviors and improve overall voice quality, thereby replace surgical intervention in some cases or act as a complementary treatment to enhance the ultimate therapeutic outcomes. This study aims to explore the short-term effect of the Accent method of VT on vocal subjective measures and acoustics in professional users with MAPLs, evaluate the responsiveness of each vocal fold lesion to the VT, and propose a simple model for providing VT to a sector of the population in great need of non-invasive management.

Materials and methods

This analytical cross-sectional included fifty professional voice users with different MAPLs were exposed to multidimensional voice assessments before and after receiving VT training in a tertiary care hospital. These assessments include GRBAS score, Multidimensional Voice Program (MDVP) and validated Arabic version Voice Handicap Index (VHI-30).

Results

This study showed variable positive effects of VT on the different types of MAPLs. Cysts had the highest level of responsiveness to VT in comparison to other lesions, followed by nodules, polyps, contact granuloma, and Reinke's edema.

Conclusions

VT is a substantial solution for managing voice disorders. It should be considered in the management plan of the various types of MAPLs, even in Reinke's edema, which showed the minimum improvement.

Analysis of Surgical Recurrence after Larynx Microsurgery for Benign Lesions

Introduction  The study of larynx lesions is of great importance. More than 50% of people with vocal complaints have benign vocal fold alterations and some require surgery. Objective  To determine which factors are related to surgical recurrence of benign laryngeal lesions and to determine which videolaryngoscopic diagnoses are related to the risk or protection of surgical relapses over time. Methods  Observational, analytical, cross-sectional study with retrospective data collection of 1,383 surgeries in 1,301 patients. Results  The mean age at the first surgery was 39.2 years old. The predominant gender was female (65.6%). There were 396 cases of polyps (25.34%), 349 cases of cysts (22.33%), 261 cases of Reinke edema (16.7%), 175 cases of nodules (11.2%), 153 cases of minor structural alterations (MSAs) (9.79%), 94 cases of leukoplakia (6.01%), 77 cases of granulomas (4.93%) and 58 cases of pseudocysts (3.71%). The age presented statistical significance with the risk of surgical relapses ( p  = 0.016). Male gender was associated with the greatest chance of relapse. Diagnosis of granuloma ( p  < 0.001) and of leukoplakia ( p  < 0.001) were associated with a higher risk of surgical recurrence. Cyst diagnosis was associated with protection ( p  = 0.015) in relation to the chance of further surgeries. Patients with associated lesions, bilaterals or voice professionals did not present a statistically significant association with surgical recurrence. Conclusion  Age and gender are statistically related to the increase of surgical relapses. Leukoplakia and granuloma are associated with increased surgical relapses. Patients submitted to cyst microsurgery appear to be protected against surgical recurrence.

[Linguistic adaptation and validation of the voice handicap index (VHI)-30 in patients with dysphonia into Russian]

Purpose of the study is to assess the internal consistency, reliability of retesting and clinical reliability of the Russian version of the Voice Handicap Index (VHI)-30 questionnaire.

MATERIAL AND METHODS

It is prospective observational study. The original English version of the VHI-30 questionnaire was translated into Russian by two independent researchers (professional translators). The final Russian version (VHI-30rus) was formulated by a third researcher (otorhinolaryngologist) on the basis of these two translations, and then translated back into English. The 181 participants were included in this study. The main group patients (n=91) were additionally divided into subgroups in accordance with the form of dysphonia: 65 (71.4%) patients had functional and organic dysphonia, 8 (8.8%) had chronic inflammatory diseases of the larynx, 7 (7.7%) - benign neoplasms of the larynx (singing nodules, polyps, cysts), 11 (12.1%) - unilateral laryngeal paralysis. The control group consisted of 90 people without voice disorders. Internal consistency (Cronbach's α coefficient), retest reliability (intraclass correlation coefficient (ICC) VHI-30, comparison of VHI-30 indicators of patients and studied control group (Mann-Whitney U-test, Kruskal-Wallis test) and correlation with the overall severity of dysphonia (Spearman's ρ rank correlation coefficient) were determined.

RESULTS

In the patient group, we observed excellent internal consistency for VHI-30rus (α=0.95) and good internal consistency for all VHI-30rus subscales: physical (α=0.88), functional (α=0.88), and emotional (α=0.88). The intraclass correlation coefficient (ICC) indicated high retest reliability for patients (0.99) and control group subjects (0.84). The 30-item mean total values for patients with dysphonia were statistically significantly higher than for control group participants (p<0.001). A correlation was found between the overall VHI-30rus value and the overall severity of dysphonia (ρ=0.748, p<0.001). In the patient's group, female and male participants showed a statistically insignificant difference in the total value of VHI-30rus (Mann-Whitney U-test, p<0.001). There was a correlation in terms of VHI-30rus indicators in different subgroups of the patient group and the control group (Spearman's correlation coefficient: functional dysphonia - 0.942; chronic laryngitis - 0.756; unilateral laryngeal paralysis - 0.888; benign neoplasms - 0.982; control group studied - 0.882).

CONCLUSION

As a result of this study, the VHI-30 questionnaire was translated from English into Russian for use in the Russian-speaking environment. The study showed good internal consistency, retest reliability, and clinical validity for the Russian version of the VHI-30rus questionnaire. The VHI-30rus questionnaire can be recommended for use in clinical practice for patients with dysphonia.

Management of benign vocal fold lesions: current perspectives on the role for voice therapy

PURPOSE OF REVIEW

Benign vocal fold lesions (BVFLs) cause dysphonia by preventing full vocal fold closure, interrupting vibratory characteristics and increasing compensatory muscle tension. Management includes phonosurgery, voice therapy, pharmacological treatment or more commonly a combination of these interventions. This review aims to present current perspectives on the management of BVFLs, particularly exploring the role of voice therapy.

RECENT FINDINGS

The review highlights variation in the management of BVFLs. There is evidence that phonosurgery is a well tolerated and effective intervention for BVFLs. Primary voice therapy can frequently prevent surgery in vocal fold nodules and some types of polyps. Used as an adjunct to phonosurgery, preoperative and postoperative voice therapy can improve patient-reported outcomes and acoustic parameters of the voice. However, heterogeneity of studies and poor descriptions of intervention components prevent a robust analysis of the impact of voice therapy.

SUMMARY

The current evidence consists of low-level studies using mixed aetiology groups, which compromises internal and external validity. There are a few exceptions to this. Poor reporting and heterogeneous methodologies lead to difficulties determining the components of a voice therapy intervention for this population. Consequently, we are unable to evaluate, which intervention elements are beneficial to patients.

Vocal fold nodules: A disorder of phonation organs or auditory feedback?

OBJECTIVE

Increasing evidence supports that auditory feedback of one's own voice closely relates to real-time adjustments of vocal control. Previous studies highlighted that the low-frequency modulations of below 3 Hz (LFM) embedded in vocal fundamental frequency (F0) showed a reflex-like response to altered auditory inputs. However, the auditory feedback control of different vocal disorders remains unclear.

DESIGN

A cross-sectional, case-controlled study.

SETTING

A tertiary medical centre.

PARTICIPANTS

Sustained vocalisations of vowel/a/ from adult healthy controls and patients with vocal fold nodules, vocal fold polyps and vocal fold cysts, respectively. The vocalisations were made at a comfortable pitch and at the intensity of 70 ~ 80 dBC under the following four auditory conditions: natural hearing, 90-dBC speech noise, 10-dBC enhanced feedback of self-produced voice and both the noise and voice feedback.

MAIN OUTCOME MEASURES

Power spectral analysis of F0 contour of sustained vowel.

RESULTS

Patients with vocal fold nodules presented with different audio-vocal feedback behaviour and audio-vocal response to speech noise from the other two vocal pathologies of vocal fold polyp and vocal fold cyst as well as the healthy controls (P < .001, one-way ANOVA).

CONCLUSION

The vocal fold nodules may be not only a vocal fold disease but also a disease caused by abnormal audio-vocal feedback. Moreover, the distinct audio-vocal feedback of vocal fold nodules could be revealed by power spectral analysis of vocal fundamental frequencies. Although further investigations are necessary, adjustments of audio-vocal feedback behaviour may provide a new insight and benefit to the treatment of vocal fold nodules in the future.

Updated Medical and Surgical Treatment for Common Benign Laryngeal Lesions

Benign laryngeal lesions are often the result of phonotraumatic forces on the vocal folds and thus classically are treated with a combination of voice therapy and phonomicrosurgical techniques to minimize inadvertent additional trauma. Newer management strategies expand on these techniques with the use of the pKTP laser as well as intralesional injections, both in the operating room and in the awake outpatient setting.

Vocal Hygiene Education Program Reduces Surgical Interventions for Benign Vocal Fold Lesions: A Randomized Controlled Trial

Objectives/Hypothesis

Vocal fold polyps and nodules are common benign laryngeal lesions. Currently, the Japanese health insurance system covers surgical interventions. However, the establishment of more cost‐effective conservative methods is required, because healthcare costs are viewed as a major concern, and the government and taxpayers are demanding more economical, effective treatments. In this situation, more suitable vocal hygiene education may be important for the success of cost‐effective conservative treatment. In this study, we developed a novel reinforced vocal hygiene education program and compared the results of this program with those of previous methods of teaching vocal hygiene.

Study Design

Multicenter randomized controlled trial.

Methods

Patients who visited a National Hospital Organization (NHO) hospital for the surgical indication of hoarseness were included in the study. Before undergoing surgery, 200 patients with benign vocal fold lesions (vocal fold polyps/nodules) were enrolled and randomly allocated to the NHO‐style vocal hygiene educational program (intervention group) or control education program (control group). Two months after enrollment, the patients in both groups underwent laryngeal fiberscopic examinations to determine whether the benign lesions had resolved or whether surgery was indicated for the vocal fold polyps/nodules.

Results

After 2 months, in the intervention group, the proportion of lesion resolution (61.3%) was significantly greater than that in the control group (26.3%) (P < .001, Fisher exact test).

Conclusions

Our results clearly indicate that the quality and features of the education program could affect the outcome of the intervention. We found that a reinforced vocal hygiene education program increased the rate of the resolution of benign vocal fold polyps and nodules in a multicenter randomized clinical trial.

Level of Evidence

1b Laryngoscope, 2593–2599, 2018

Efficacy of Phonosurgery, Logopedic Voice Treatment and Vocal Pedagogy in Common Voice Problems of Singers

INTRODUCTION

Functional and organic impairments of the singing voice are common career-threatening problems of singers presenting in phoniatric and laryngological departments. The objective was to evaluate the efficacy of phonosurgery, logopedic voice treatment and vocal pedagogy in common organic and functional voice problems of singers, including investigation of the recently introduced parameter vocal extent measure (VEM).

METHODS

In a prospective clinical study, the analysis of treatment outcome in 76 singers [57 female, 19 male; 38 ± 11 years (mean ± SD)] was based on pre- and post-therapeutic voice function diagnostics and videolaryngostroboscopy. Examination instruments included auditory-perceptual voice assessment, voice range profile (VRP), the VEM calculated from area and shape of the VRP, acoustic-aerodynamic analysis, and patients' self-assessment (e.g., Singing Voice Handicap Index).

RESULTS

While 28% of all singers (21/76) presented with functional dysphonia, 72% (55/76) were diagnosed with organic vocal fold changes, of which marginal edema (n = 25), nodules (n = 9), and polyps (n = 8) were the most common pathologic changes. Of the 76 singers, 57% (43) received phonosurgery, 43% (33) had conservative pedagogic (14) and logopedic (19) treatment. Three months post-therapeutically, most parameters had significantly improved. The dysphonia severity index (DSI) increased on average from 6.1 ± 2.0 to 7.4 ± 1.8 (p < 0.001), and the VEM from 113 ± 20 to 124 ± 14 (p < 0.001). Both parameters correlated significantly with each other (rs = 0.41). Phonosurgery had the largest impact on the improvement of vocal function. Conservative therapies provided smaller quantitative enhancements but also qualitative vocal restoration with recovered artistic capabilities.

CONCLUSIONS

Depending on individual medical indication, phonosurgery, logopedic treatment and voice teaching are all effective, objectively and subjectively satisfactory therapies to improve the impaired singing voice. The use of VEM in singers with functional and organic dysphonia objectifies and quantifies their vocal capacity as documented in the VRP. Complementing the established DSI, VEM introduction into practical objective voice diagnostics is appropriate and desirable especially for the treatment of singers.

Voice rest after laryngeal surgery: what's the evidence?

PURPOSE OF REVIEW

This article aims to review previous research reports and to summarize current strategies for the optimal duration of voice rest and the effect of phonatory stimulation after phonomicrosurgery.

RECENT FINDINGS

Voice rest is commonly recommended after laryngeal surgery to prevent worsening of vocal fold injuries. However, there are no established standard protocol for voice rest, and the type and duration of voice rest vary among clinicians. The most effective duration of voice rest is unknown. Recently, early vocal stimulation was recommended as a means to improve wound healing, on the basis of the basic and clinical researches.

SUMMARY

It seems that early vocal stimulation may enhance the wound healing process in the vocal fold. More basic and clinical researches are warranted to investigate appropriate timing of initiation of stimulation, as well as the type and amount of stimulation that are available for human.

Long-term Surveillance Following Intralesional Steroid Injection for Benign Vocal Fold Lesions

Importance

The short-term outcomes of vocal fold steroid injection (VFSI) are well documented. However, few studies have reported the long-term outcomes following VFSI.

Objective

To investigate the incidence rates of symptom recurrence and secondary interventions following VFSI for benign vocal fold lesions.

Design, Setting, and Participants

This prospective cohort study was conducted at a tertiary referral medical center in Taipei, Taiwan. The cohort included 189 patients with vocal fold lesions who had received VFSI as the primary treatment between August 2011 and September 2013.

Exposures

All participants underwent VFSI.

Main Outcomes and Measures

Long-term surveillance was conducted through structured telephonic interviews and by reviewing medical charts every 6 months over a 2-year period. We assessed the 10-item voice handicap index, dysphonic symptoms, and whether the patients had received any additional interventions after the initial VFSI.

Results

The 189 participants (32 men and 157 women; mean [SD] age, 39 [10] years [range, 20-74 years] included patients who had undergone VFSI for vocal fold nodules (n = 72), polyps (n = 72), or mucus-retention cysts (n = 45). Following VFSI, 141 patients (74.6%; 23 men and 118 women; mean age, 39 years [range, 20-70 years]) showed positive response (ie, clinically significant symptom resolution without the need for additional procedures) and received long-term surveillance. The median follow-up period was 19.4 months, and 2 patients were lost to follow-up postoperatively within 1 year. The cumulative failure rates (subjective symptom recurrence plus secondary treatments) at 6, 12, 18, and 24 months after VFSI were 12%, 17%, 24%, and 32%, respectively. When the initial response rate to VFSI (141 of 189, 74.6%) was considered altogether, VFSI remained effective after 2 years in 50% of the initially recruited 189 patients. The highest rate of long-term effectiveness of VFSI occurred in vocal polyps (54%), followed by nodules (49%) and cysts (43%).

Conclusions and Relevance

This study demonstrates that VFSI can be beneficial in managing benign vocal lesions, especially when first-line treatments are unsuitable. However, the long-term results of this study clarify that a substantial number of patients experience symptom recurrence or receive subsequent interventions within 2 years after VFSI; this should be considered in medical decision making.

Is Acupuncture Efficacious for Treating Phonotraumatic Vocal Pathologies? A Randomized Control Trial

OBJECTIVES

To investigate the effectiveness of acupuncture in treating phonotraumatic vocal fold lesions.

STUDY DESIGN/METHODS

A total of 123 dysphonic individuals with benign vocal pathologies were recruited. They were given either genuine acupuncture (n = 40), sham acupuncture (n = 44), or no treatment (n = 39) for 6 weeks (two 30-minute sessions/wk). The genuine acupuncture group received needles puncturing nine voice-related acupoints for 30 minutes, two times a week for 6 weeks, whereas the sham acupuncture group received blunted needles stimulating the skin surface of the nine acupoints for the same frequency and duration. The no-treatment group did not receive any intervention but attended just the assessment sessions. One-hundred seventeen subjects completed the study (genuine acupuncture = 40; sham acupuncture = 43; and no treatment = 34), but only 84 of them had a complete set of vocal functions and quality of life measures (genuine acupuncture = 29; sham acupuncture = 33; and no-treatment = 22) and 42 of them with a complete set of endoscopic data (genuine acupuncture = 16; sham acupuncture = 15; and no treatment = 11).

RESULTS

Significant improvement in vocal function, as indicated by the maximum fundamental frequency produced, and also perceived quality of life, were found in both the genuine and sham acupuncture groups, but not in the no-treatment group. Structural (morphological) improvements were, however, only noticed in the genuine acupuncture group, which demonstrated a significant reduction in the size of the vocal fold lesions.

CONCLUSIONS

The findings showed that acupuncture of voice-related acupoints could bring about improvement in vocal function and healing of vocal fold lesions.

Adaptation and Validation of the Voice Handicap Index (VHI)-30 into Serbian

OBJECTIVES

To evaluate the internal consistency, test-retest reliability, and clinical validity of the Serbian version of the self-administered Voice Handicap Index (VHI)-30.

STUDY DESIGN

Cross-sectional study.

METHODS

The English version of VHI-30 was translated into Serbian and then back-translated into English. The Serbian VHI-30 was administered to 91 patients divided into four groups according to voice pathology: structural, inflammatory, neurologic, and functional groups. The control group included 90 subjects with no voice problems. The internal consistency (Cronbach's alpha coefficient α), test-retest reliability (interclass correlation coefficient) of VHI-30, comparison of patient's and control's VHI-30 scores (Mann-Whitney U test; Kruskal-Wallis test), and correlation with overall severity of dysphonia (Spearman correlation coefficient, ρ) were calculated.

RESULTS

In the patient group, we observed excellent internal consistency for the Serbian VHI-30 (α = 0.95) and good internal consistency for all VHI-30 subscales: physical (α = 0.88), functional (α = 0.88), and emotional (α = 0.88). The interclass correlation coefficient indicated strong test-retest reliability for patients (0.99) and controls (0.84). The mean scores of all 30 items in dysphonic participants were significantly higher than in controls (P < 0.001). Good correlation was obtained between the total scores of VHI-30 and patients' self-perceived overall severity of dysphonia (ρ = 0.748, P < 0.001). Within the patient group, the female participants displayed significantly higher VHI-30 scores than male participants (Mann-Whitney U test, P < 0.001). The VHI-30 scores showed strong correlation within different patient groups and controls (Spearman correlation coefficient: structural, 0.942; inflammatory, 0.756; neurologic, 0.888; functional, 0.982; controls, 0.882).

CONCLUSIONS

The Serbian VHI-30 is a useful and valuable tool for the evaluation of patients with vocal disorders and for making subsequent clinical decisions.

Wound-healing effect of acupuncture for treating phonotraumatic vocal pathologies: A cytokine study

OBJECTIVES/HYPOTHESIS

Acupuncture is a less-invasive procedure when compared with surgical treatment for benign vocal pathologies caused by vocal overuse. This study aimed to determine the wound-healing effect of acupuncture in treating phonotraumatic vocal fold lesions.

STUDY DESIGN

Two-way, mixed-model, between- and within-subjects, prospective randomized, placebo-controlled, blinded group design.

METHODS

Seventeen dysphonic individuals with vocal nodules were recruited from a university clinic in Hong Kong. Each participant was randomly assigned to receive one session of either genuine or sham acupuncture. The genuine acupuncture group (n = 9) received needles puncturing nine voice-related acupoints for 30 minutes, whereas the sham acupuncture group (n = 8) received blunted needles stimulating the skin surface of the nine acupoints for the same frequency and duration. Laryngeal secretions were suctioned from the surface of the vocal folds immediately before, immediately after, and 24 hours after the acupuncture. The protein concentration levels of wound-healing-related cytokines (interleukin [IL]-1β and IL-10) in these secretion samples were measured.

RESULTS

Following acupuncture, a significant increase in the anti-inflammatory cytokine IL-10 was found in the genuine acupuncture group (n = 9) but not in the sham acupuncture group (n = 8).

CONCLUSIONS

The findings showed that acupuncture of voice-related acupoints facilitated an anti-inflammatory process in phonotraumatic vocal pathologies. This could be considered as supporting evidence to consider acupuncture as a less-invasive alternative option, when compared to surgery, for treating phonotraumatic vocal pathologies.