Isolated and Combined Respiratory Training for Muscle Tension Dysphonia: Preliminary Findings

Toward Sham Interventions for Behavioral Voice Treatment Outcome Research in Female Students Without Dysphonia

OBJECTIVES/HYPOTHESIS

To develop sham voice treatment techniques to be used in voice treatment outcome research, and to investigate their effectiveness as sham. This entails that the techniques induce no changes in voice or voice physiology, yet still lead to a perception of efficacy.

STUDY DESIGN

Prospective randomized blinded controlled study.

METHODS

Three distinct sham intervention protocols (SIPs) were conceptualized as placebic comparators for three common voice treatment approaches with focus on vocalization (SIP1), respiration (SIP2), and manipulation (SIP3). Forty-eight female students participated in the study. Each participant attended ten 30-minute sessions over 5weeks, including a baseline evaluation, three sessions of one SIP, an inter-SIP voice assessment, three sessions of a second SIP, and a final post-SIP assessment. Auditory-perceptual and instrumental voice evaluations were used as voice treatment outcome measures. The participants' perception of voice-related quality of life was evaluated using the French Voice Handicap Index (VHIFR). Frequentist as well as Bayesian statistical methods were applied for group comparisons. The effects of combining two SIPs, the potential influence of SIP order, and experimenter/clinician effects, were also investigated.

RESULTS

The respiration-based SIP2 showed changes only in sound intensity level on a sustained vowel across the three sham intervention sessions. In contrast, the vocalization-based SIP1 impacted sound intensity level on a sustained vowel, sound intensity level on read text, and maximum phonation time. The manipulation-based SIP3 affected smoothed cepstral peak prominence on read text, Acoustic Voice Quality Index, and Dysphonia Severity Index. SIP2 thus demonstrated the highest alignment with the study's objectives, followed by SIP1 and SIP3. GRBASI ratings revealed no statistical differences for any SIP. VHIFr decreased significantly after all three SIPs. Combining the SIPs generally replicated the effects observed when each SIP was used individually. There was no order effect or experimenter/clinician effect on the results.

CONCLUSIONS

This study demonstrated significant changes in participants' perceived voice quality (measured with VHIFr) across various SIPs, despite minimal impact on objective voice function measures. Further investigation is necessary to establish one or more protocols as genuinely sham interventions.

Integration of Dysphagia Therapy Techniques into Voice Rehabilitation: Design and Content Validation of a Cross-Therapy Protocol

BACKGROUND

The intricate relationship between swallowing and phonation, sharing anatomical and physiological substrates, underscores a clinical demand for integrated therapeutic approaches. Existing interventions often address these functions in isolation, overlooking their interconnected dynamics.

OBJECTIVE

To design and validate a cross-therapy protocol incorporating dysphagia therapy techniques (maneuvers/exercises) into voice rehabilitation. This protocol aims to exploit the shared biomechanical components of swallowing and phonation to improve both functions simultaneously in patients with underlying hypofunctional laryngeal pathology.

METHODS

A descriptive research design was employed, consisting of three phases: a comprehensive literature review and expert discussions in a German seminar format to conceptualize the protocol; detailed analysis and categorization of swallowing maneuvers/exercises; and content validation by a panel of seven experts through a structured evaluation instrument. The process integrated motor learning and exercise physiology principles to ensure the protocol's clinical applicability and theoretical coherence.

RESULTS

The developed cross-therapy protocol incorporates four core swallowing therapy techniques to voice therapy procedures. Selected swallowing therapy techniques target laryngeal excursion and vocal fold closure because they are critical components of swallowing and phonation. Expert validation yielded a Content Validity Coefficient exceeding 0.90 for most items, indicating high consensus on the protocol's relevance, clarity, and applicability. Adjustments were made based on feedback, enhancing the protocol's precision and user-friendliness.

CONCLUSION

We present a novel, evidence-based therapy protocol for voice and swallowing difficulties resulting from hypofunctional laryngeal pathology. Its development marks a significant step toward bridging the gap between swallowing and voice therapy. Future empirical studies are needed to assess its effectiveness in clinical settings.

The role and impact of voice physiotherapy: A qualitative study of service user perspectives

BACKGROUND

Physiotherapy has the potential to benefit people with voice and throat problems in conjunction with existing services.

PURPOSE

This study aims to explore the impact and role of physiotherapy in voice and throat care, from the perspective of people who have accessed such care. Gaining a better understanding of how physiotherapy contributes to care has the potential to improve services.

METHODS

An interpretive description design was used to explore participants perspectives of the impact and role of physiotherapy through individual semi-structured interviews with people who had accessed physiotherapy for voice or throat care through a single private practice. Transcripts were analyzed with a general inductive approach suitable for qualitative evaluation data. Data were analyzed from six interviews and four main themes emerged, with each theme further characterized by categories.

RESULTS

Two themes related to the impact of physiotherapy in voice and throat care: Offers a deeper understanding of issues affecting their voice/throat; facilitates individualized specific management. Two themes related to the role of physiotherapy in voice and throat care: Complements existing services; Valuable service. Each theme is further illustrated by categories.

CONCLUSION

This study indicates that physiotherapy for voice and throat problems can complement existing services while adding value, providing people with a deeper understanding of their problem and facilitating specific management. There is great potential for physiotherapy to benefit voice users. Future research should further evaluate the potential to include physiotherapy in the voice care team and consider how best to capture the broad impacts illustrated.

[Application of the biofeedback method in the treatment of dysphonia (literature review)]

The literature review describes the experience of using the biofeedback method in the treatment of dysphonia of various etiologies. Indications for the use of this method and its effectiveness in a certain contingent of patients are discussed.

The Additive Effectiveness of Inspiratory Muscle Training on Glottic Closure and Subjective Voice Outcomes of Patients With Benign Lesion After Hyaluronic Acid Laryngoplasty

OBJECTIVES

For patients with glottic insufficiency disease, injection laryngoplasty is a rapid and efficient management option that complements voice therapy. Some studies have indicated that respiratory muscle training may also show promise in patients with voice disorders. However, the effect of respiratory muscle training in patients with glottic insufficiency was reported to be limited, and whether it provides additional benefit after standard management requires further evaluation. We aimed to investigate the effectiveness of inspiratory muscle training on glottis closure and patient-reported voice quality in glottic insufficiency patients who had been treated with hyaluronic acid injection.

STUDY DESIGN

Retrospective observational study.

METHODS

We included 46 patients with glottic insufficiency who had undergone hyaluronic acid injection. Twenty of them had undergone inspiratory muscle training during three months. We measured patients' changes in glottic status according to the normalized glottal gap area and bowing index, as well as voice quality of life according to the voice handicap index 10 and the voice outcome survey, before and after training.

RESULTS

Patients who underwent inspiratory muscle training had higher odds of experiencing better improvement in all scores. The range of odds ratios ranged from 2.5 to 6.3 for changes in scores, and from 3.8 to 22.2 for changes in score percentages. Of note, the effect of training on percentage changes in the normalized glottal gap area score was significant (P= 0.0127) after adjustment for the duration of vocal disease, body mass index and BMI, and history of gastroesophageal reflux disease.

CONCLUSIONS

Inspiratory muscle training can improve the glottal gap after injection laryngoplasty, and may be applied in clinical practice.

Integrative Review and Framework of Suggested Mechanisms in Primary Muscle Tension Dysphonia

PURPOSE

Despite the high prevalence of primary muscle tension dysphonia (MTD-1), its underlying mechanisms and their interrelationships have yet to be fully identified. The objectives of this integrative review were (a) to describe and classify the suggested underlying mechanisms for MTD-1, (b) to appraise the empirical evidence supporting each of the proposed mechanisms, and (c) to summarize the information in an integrative model.

METHOD

PubMed, Scopus, and CINAHL were searched for all publications pertaining to muscle tension dysphonia. Papers were retained if they included theoretical or empirical data pertaining to underlying mechanisms of MTD-1. A total of 921 papers initially qualified for screening, of which 100 remained for consideration in this review. Underlying mechanisms of MTD-1 were extracted using a consensus approach.

RESULTS

Seven broad categories of putative mechanisms involved in MTD-1 were identified: psychosocial, autonomic, sensorimotor, respiratory, postural, inflammatory, and neuromuscular. These categories were further divided into 19 subcategories detailed in the body of this review article. Based on the reviewed evidence, our proposed integrative model presents MTD-1 as an idiosyncratic motor adaptation to physiological perturbation or perceived threat. Under this model, physiologically or psychologically aversive stimuli can instigate a series of motor adaptations at multiple levels of the nervous system, ultimately disturbing muscle activation patterns and their biomechanical outcomes. Importantly, these adaptations appear to have the potential to become chronic even after threatening stimuli are withdrawn.

CONCLUSIONS

The proposed model highlights the importance of personalized rehabilitation in MTD-1 treatment. Limitations of the literature are discussed to provide guidance for future research aimed at improving our understanding of MTD-1.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19586065.