An interdisciplinary approach to the treatment of a hyperfunctional voice disorder

A Comparison of Voice and Psychotherapeutic Treatments for Adults With Functional Voice Disorders: A Systematic Review

OBJECTIVE

To examine the effect of traditional voice therapy and cognitive therapy on the voice and client-wellbeing outcomes in adults with functional voice disorders (FVD).

METHODS

A systematic review of English articles was conducted using Medline (Ovid), Embase (Elsevier), CINAHL (Ebsco), The Cochrane Central Register of Controlled Trials (CENTRAL), PsychInfo (Ebsco) and Speechbite from inception to current date. Additional studies were identified through bibliographies and authors were contacted when further information was required from an article. All study designs were included with pretest/posttest outcome measures related to voice. Independent extraction of studies was completed by three authors using predefined data fields and quality assessment tools.

RESULTS

Outcomes of 23 studies (2 RCTs and 21 cohort or case studies) are summarised using a narrative style due to heterogeneity of interventions and outcome scales used. Overall research quality of included studies was low, with many cohort and case studies lacking controls, blinding and robust outcome measures.

CONCLUSIONS

There are some benefits to pairing cognitive behavioural therapy (CBT) with traditional voice therapy for FVD including improved voice quality, psychosocial wellbeing and prevention of relapse. It is feasible to train speech-language pathologists (SLPs) in CBT-enhanced voice therapy. Further high-quality research is needed, however, to guide the clinical implementation of CBT for the management of FVD.

Surface electromyographic biofeedback for behavioral dysphonia in adult people: a systematic review

PURPOSE

To review systematically the literature and to analyze the effectiveness of surface electromyographic biofeedback in the rehabilitation of adults with behavioral dysphonia.

RESEARCH STRATEGIES

Two authors performed an independent search in the following databases: Clinical Trials, Cochrane Library, Embase, LILACS, PubMed, and Web of Science. A specific search strategy was developed for each database.

SELECTION CRITERIA

The review included studies that examined the effectiveness of surface electromyographic biofeedback compared to other direct vocal therapy intervention in adults with behavioral dysphonia. There were no restrictions in regard to language or date of publication.

DATA ANALYSIS

Analysis of the risk of bias, heterogeneity, quantitative and qualitative data, sensitivity, subgroups, and publication bias.

RESULTS

51 studies were identified, but only two cohort studies remained as prospects for analysis. The studies showed 100% uncertain risk of selection, performance, and detection bias. There was a high degree of clinical heterogeneity. The descriptive analysis showed a reduction in muscle electrical activity and improvement in vocal self-assessment using electromyographic biofeedback; however, it was not possible to calculate the effect size of the interventions. The present study was limited by the fact that it was unable to show a consensus for the majority of data analyzed.

CONCLUSION

The available literature does not support a conclusive finding about the effectiveness of surface electromyographic biofeedback compared to other direct interventions used in the rehabilitation of adults with behavioral dysphonia. The studies analyzed vary widely in their clinical procedures and methodology, making it impossible to determine the procedure's effectiveness.

Comprehensive management of psychogenic dysphonia: a case illustration

Psychogenic dysphonia refers to the loss of voice, in the absence of apparent structural or neurological pathology. It is a disorder seen more often in women and is usually associated with significant life events and emotional difficulties that may lead to conflict over speaking. Therapeutic interventions in voice disorders recommend the adoption of a multidisciplinary approach to treatment. The following is a case illustration of a 50-year-old married lady with dysphonia and significant marital difficulties.

LEARNING OUTCOMES

The case demonstrates the psychological issues in the onset and maintenance of psychogenic voice disorders. It also emphasizes the use of a multidisciplinary approach consisting of cognitive behavioural strategies, pharmacological inputs and voice therapy. The case illustration will also help the reader to focus on cultural issues relevant in the development of problems and the need to address these in psychotherapeutic interventions, as well as difficulties that are likely to be encountered in therapeutic interventions.

Effects of biofeedback in phonatory disorders and phonatory performance: a systematic literature review

The purpose of this article was to systematically review the literature on the effects of biofeedback therapy in the domain of phonatory disorders and phonatory performance, using studies in peer-reviewed journals. An extensive definition of biofeedback is given and its place in voice treatment is defined. Eighteen group or case studies or reports considering the effects of electromyographic, laryngoscopic and acoustic biofeedback in dysphonic patients (hyperfunctional voice disorders, hypofunctional voice disorders, psychogenic voice disorder, laryngeal trauma, total laryngectomy, vocal cord dysfunction) and participants with normal voices are included and an analysis of procedure as well as research design and results is presented. The usefulness of biofeedback in phonatory disorders and performance was to be interpreted based on tendencies, since there is a lack of randomized controlled efficacy studies. In only 3 of 18 studies (16.7%) did biofeedback therapy fail to improve voice quality or not result in better results than other forms of therapy. Recommendations for improved methodologies are made, which include the use of acoustic voice quality parameters.

Successful interdisciplinary intervention with an initially treatment-resistant social phobic

Despite very successful treatments for social phobia, with many studies reporting as many as 75% of social phobics making clinically significant gains with 3 months of treatment or less, some social phobics fail to respond to treatment. This case presents a women with social phobia who received several trials of treatment for severe public-speaking fears but failed to improve, as demonstrated by persistent reports of fear and avoidance equal to those before treatment. With the assistance of a speech language pathologist, this client received combined therapy that included cognitive-behavioral therapy to treat her public-speaking fear and avoidance and voice therapy to treat excessive muscle contractions in the respiratory and phonatory systems. Overall, the combined treatment was successful, with the client's self-reported levels of fear and avoidance of public speaking decreasing dramatically. Specific improvements during voice therapy and implications for the treatment of social phobia are also discussed.