Pre- and Postoperative Voice Therapy for Benign Vocal Fold Lesions: An International Electronic Delphi Consensus Study

Clinical Voice Outcomes for Two Voice Rest Protocols after Phonomicrosurgery

OBJECTIVES

Voice rest is commonly recommended for patients with benign vocal fold lesions (BVFLs) after phonomicrosurgery. The study compares the clinical voice outcomes of two protocols, 7-day complete voice rest (CVR) and 3-day CVR followed by 4-day relative voice rest (CVR + RVR), for patients with BVFLs after phonomicrosurgery.

STUDY DESIGN

Prospective, randomized controlled trial.

METHOD

Patients with BVFLs undergoing phonomicrosurgery were recruited prospectively and randomly assigned to either protocol. Outcomes were assessed on objective measures of acoustics (fundamental frequency, frequency range, mean intensity, cepstral peak analysis) and aerodynamics (vital capacity, airflow rate, subglottal pressure, phonation threshold pressure), as well as subjective measures, both provider-reported through the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and patient-reported through the Voice Handicap Index (VHI). Clinical measures were collected at three-time points: preoperatively, 1-week postoperatively (on voice rest), and 1-month postoperatively. In addition, adherence was estimated using a vocal dosimeter.

RESULTS

Twenty-five patients were recruited and randomized to 7-day CVR (n = 13) and CVR + RVR regimen (n = 12). Statistically significant changes were found within both groups for subglottal pressure (p = 0.03) and VHI score (p < 0.001) comparing pre-operative baseline to 1-month postoperative follow-up. There were no statistically significant differences between the groups. Regardless of group assignment, a significant decrease in overall severity ratings for the CAPE-V was found by comparing the preoperative scores to postoperative scores at 1-week (p < 0.001) and 1-month (p < 0.001).

CONCLUSION

Both groups improved their overall voice quality comparably 1 month after undergoing phonomicrosurgery as measured by objective and subjective parameters.

LEVELS OF EVIDENCE

2. Laryngoscope, 134:2812-2818, 2024.

Pre- and post-operative voice therapy for benign vocal fold lesions: protocol for a non-randomised, multicentre feasibility trial with embedded process evaluation

BACKGROUND

Management of benign vocal fold lesions (BVFLs) is variable with individuals receiving surgery, voice therapy, or a combination of these approaches. Some evidence suggests that the best outcomes may be achieved when patients are offered pre- and post-operative voice therapy in addition to phonosurgery, but what constitutes pre- and post-operative voice therapy is poorly described. The pre- and post-operative voice therapy (PAPOV) intervention has been developed and described according to the TIDieR checklist and Rehabilitation Treatment Specification System (RTSS) for voice. The PAPOV intervention is delivered by specialist speech and language therapists trained in the intervention and comprises 7 essential and 4 additional components, delivered in voice therapy sessions with patients who are having surgery on their vocal folds for removal of BVFLs.

STUDY DESIGN

Non-randomised, multicentre feasibility trial with embedded process evaluation.

METHOD

Forty patients from two sites who are due to undergo phonosurgery will be recruited to receive the PAPOV intervention. Measures of feasibility, including recruitment, retention, and adherence, will be assessed. The feasibility of gathering clinical and cost effectiveness data will be measured pre-treatment, then at 3 and 6 months post-operatively. An embedded process evaluation will be undertaken to explain feasibility findings.

DISCUSSION

This study will assess the feasibility of delivering a described voice therapy intervention protocol to patients who are undergoing surgery for removal of BVFLs. Findings will be used to inform the development and implementation of a subsequent effectiveness trial, should this be feasible.

TRIAL REGISTRATION

This trial has been prospectively registered on ISRCTN (date 4th January 2023), registration number 17438192, and can be viewed here: https://www.isrctn.com/ISRCTN17438192 .